CARDIOPULMONARY-RESUSCITATION IN ELDERLY PATIENTS HOSPITALIZED IN THE1990S - A FAVORABLE OUTCOME

Objective: To compare the clinical characteristics and survival of eld erly and younger hospitalized patients who sustain cardiac arrest and receive cardiopulmonary resuscitation (CPR) in the 1990's and to asses s predictors of survival. Design: Retrospective survey of cardiac arre st database and hospital charts, plus telephone follow-up. Setting: 45 0-bed acute care teaching hospital. Study Population: Seventy-eight ho spitalized patients 70 years or older and 73 hospitalized patients und er 70 years of age. Measurements: Survey of cardiac arrest data base, hospital charts, and telephonic follow-up to allow (1) comparison of c linical characteristics, survival, and long-term follow-up between two age groups and (2) univariate and multivariate analysis of predictors of mortality. Main Results: Pre-arrest clinical characteristics were not significantly different between the age groups, Prior to arrest th e majority of patients were functionally active, and over one-third we re hospitalized for acute coronary artery syndromes. In approximately 85% of the patients, the arrest was witnessed, and 70% of the patients had their cardiac rhythm monitored at onset of the arrest. Survival w as not significantly different between the age groups; 26% of the tota l 151 patients were discharged. No significant difference was noted in pre-post arrest functional status of survivors. Survival at 1, 2, and 3 years in elderly and younger survivors was 86% versus 80%, 76% vers us 67%, and 71% versus 61%, respectively. Multivariate analysis identi fied the presence of coronary artery disease, admission systolic blood pressure, and functional level to be independent pre-arrest predictor s of mortality. At the time of the arrest, the initial cardiac rhythm and duration of CPR were found to be independent predictors of mortali ty. Conclusions: Elderly patients hospitalized in the 1990's who recei ve CPR have outcomes similar to younger patients who receive CPR. The favorable outcome in the elderly patients may reflect patient selectio n: the majority of our patients were functionally active prior to hosp italization, without multiple serious illnesses; many were hospitalize d for acute coronary artery syndromes; and, in most cases, the arrest was witnessed with the patient's cardiac rhythm monitored at onset of the arrest.