ESTIMATION OF SEVERITY OF ILLNESS WITH APACHE-II - AGE-RELATED IMPLICATIONS IN CARDIAC-ARREST OUTCOMES

The ability to predict outcomes of cardiac arrest before starting card iopulmonary resuscitation (CPR) would be useful for discussions of res uscitation with elders and their families. We thought CPR outcome migh t be dependent on the severity of pre-existing illnesses. The APACHE I I is a severity-of-illness (SOI) scale based, in part, on physiologic parameters whereby points are given for degree of deviation from norma l. Additionally, up to six points are given for increased age. We hypo thesized that (1) patients with the highest APACHE II would be least l ikely to survive, and (2) because of the blunted physiologic responsiv eness, the APACHE II would underestimate the SOI of elderly patients w ho were sufficiently ill to have a cardiac arrest. A retrospective stu dy of 172 arrests was carried out to evaluate these hypotheses. For th e young cohort (n = 126; age, < 70; mean age, 59 +/- 8), mean admissio n APACHE II was 16.5 +/- 7.9 and pre-arrest APACHE II was 20.8 +/- 8.9 . For the old cohort (n = 46; age, greater-than-or-equal-to 70; mean a ge, 76 +/- 7) admission APACHE II was 17.0 +/- 5.8 (NS) and the pre-ar rest APACHE 11 was 20.3 +/- 6.5 (NS). Logistic regression analysis was carried out with both APACHE II scores and factors previously correla ted with CPR outcome. Witnessed arrests and those requiring a low numb er of medications were most likely to result in immediate success (res toration of blood pressure) and in a live discharge. APACHE II score ( 24 h pre-arrest) was associated with live discharge in the regression analysis. We conclude the pre-arrest APACHE II does add modestly to th e ability to predict outcomes of CPR efforts and measures SOI equally well in young and old cohorts.