Pre-arrest predictors of survival after resuscitation from out-of-hospital cardiac arrest in the elderly a systematic review

Abstract

BackgroundTo enable older people to make decisions about the appropriateness of cardiopulmonary resuscitation (CPR), information is needed about the predictive value of pre-arrest factors such as comorbidity, functional and cognitive status on survival and quality of life of survivors. We systematically reviewed the literature to identify pre-arrest predictors for survival, quality of life and functional outcomes after out-of-hospital (OHC) CPR in the elderly.MethodsWe searched MEDLINE (through May 2011) and included studies that described adults aged 70 years and over needing CPR after OHC cardiac arrest. Prognostic factors associated with survival to discharge and quality of life of survivors were extracted. Two authors independently appraised the quality of each of the included studies. When possible a meta-analysis of odd’s ratios was performed.ResultsTwenty-three studies were included (n = 44,582). There was substantial clinical and statistical heterogeneity and reporting was often inadequate. The pooled survival to discharge in patients >70 years was 4.1% (95% CI 3.0-5.6%). Several studies showed that increasing age was significantly associated with worse survival, but the predictive value of comorbidity was investigated in only one study. In another study, nursing home residency was independently associated with decreased chances of survival. Only a few small studies showed that age is negatively associated with a good quality of life of survivors. We were unable to perform a meta-analysis of possible predictors due to a wide variety in reporting and statistical methods.ConclusionsAlthough older patients have a lower chance of survival after CPR in univariate analysis (i.e. 4.1%), older age alone does not seem to be a good criterion for denying patients CPR. Evidence for the predictive value of comorbidities and for the predictive value of age on quality of life of survivors is scarce. Future studies should use uniform methods for reporting data and pre-arrest factors to increase the available evidence about pre arrest factors on the chance of survival. Furthermore, patient-specific outcomes such as quality of life and post-arrest cognitive function should be investigated too.

Patients' characteristics associated with the decision of “do not attempt cardiopulmonary resuscitation” order in a Swiss hospital

“…Numerous studies showed the association between age and DNACPR order, particularly in the medical team's decision, but not in the patient's view point. A recent meta-analysis shows that the older patients have a lower chance of survival after CPR (4.1%), but that evidence for the predictive value of age on quality of life of survivors is scarce, and they conclude that older age alone does not seem to be a good criterion for denying patients from CPR [30]. In our study, we found this association in the main analysis but also in the "medical team's decision" group.…”

Survival After Out-of-Hospital Cardiac Arrest in Relation to Age and Early Identification of Patients With Minimal Chance of Long-Term Survival

“…Notably, other studies support the notion that most older OHCA survivors are in acceptable health. 12,[19][20][21] Clinicians are at times faced with the dilemma of whether to continue or to terminate resuscitative efforts. These complicated decisions are often made within seconds or minutes and are frequently based solely on a clinician's prediction of survival outcome for the individual suffering a cardiac arrest.…”

“…1,[9][10][11] Accordingly, aging is associated with a concomitant increase in OHCA incidence and a low chance of survival. [1][2][3][4][5][6][10][11][12][13][14] To improve and focus future strategies for cardiac arrest management, it is important to know how changes in survival are reflected in different age groups and whether it is possible to identify patients with minimal chance of survival.…”

Knowledge and preferences regarding cardiopulmonary resuscitation: A survey among older patients

“…Of survivors 51% suffered from hypoxic-ischemic encephalopathy [1]. The survival rate of CPR out-of-hospital of people aged !70 years is just 4.1% [2]. The likely prognosis and quality of life are the main determining factors of an order to stop CPR [3].…”