Does advanced age matter in outcomes after out-of-hospital cardiac arrest in community-dwelling adults?

Objective: To assess whether advanced age is an independent predictor of su rvival to hospital discharge in community-dwelling adult patients who susta ined an out-of-hospital cardiac arrest in a suburban county Methods: A pros pective cohort study was conducted in a suburban county emergency medical s ervices system of community-dwelling adults who had an arrest from a presum ed cardiac cause and who received out-of-hospital resuscitative efforts fro m July 1989 to December 1993. The cohorts were defined by grouping ages by decade: 19-39, 40-49, 50-59, 60-69, 70-79, and 80 or more. The variables me asured included age, gender, witnessed arrest, response intervals, location of arrest, documented bystander cardiopulmonary resuscitation, and initial rhythms. The primary outcome was survival to hospital discharge. Results a re reported using analysis of variance, chi square, and adjusted odds ratio s from st logistic regression model. Age group 50-59 served as the referenc e group for the regression model. Results: Of the 2,608 total presumed card iac arrests, the overall survival rate to hospital discharge was 7.25%. Pat ients in age groups 40-49 and 50-59 experienced the best rate of successful resuscitation (10%). Each subsequent decade had a steady decline in succes sful outcome: 8.1% for ages 60-69; 7.1% for ages 70-79; and 3.3% for age 80 +. In a post-hoc analysis, further separation of the older age group reveal ed a successful outcome in 3.9% of patients ages 80-89 and 1% in patients 9 0 and older. Patients aged 80 years or more were more likely to arrest at h ome, were more likely to have an initial bradyasystolic rhythm, yet had a s imilar rate of resuscitation to hospital admission. In the regression model , age 80 or older was associated with a significantly worse survival to hos pital discharge (OR = 0.4, 95% CI = 0.20 to 0.82). Conclusions: There was a twofold decrease in survival following out-of-hospital cardiac arrest to d ischarge in patients aged 80 or more when compared with the reference group in this suburban county setting. However, resuscitation for community-dwel ling elders aged 65-89 is not futile. These data support that out-of-hospit al resuscitation of elders up to age 90 years is not associated with a univ ersal dismal outcome.