Cardiopulmonary resuscitation of older, inhospital patients: Immediate efficacy and long-term outcome

Objective: To determine the independent effect of advancing age on prognosi s after cardiopulmonary resuscitation (CPR). Design and Setting: Retrospective analysis of clinical records of patients who received CPR in a geriatric department equipped with an intensive care unit. Patients: A total of 245 patients (146 men, 99 women; mean age, 70 +/- 11 y rs) received CPR. Of these, 221 had a cardiocirculatory arrest (CA) in the intensive care unit and 24 had a CA in the general ward of the department. Acute myocardial infarction was the most frequent admission diagnosis. Interventions: CPR according to standard guidelines in all cases. Measurements and Main Results: Immediate, short-term (hospital discharge), and long-term (median follow-up, 31.5 months; range, <1-124 months) surviva l. Older patients had a lower immediate survival (<70 yrs [72/137] 52.6% vs , greater than or equal to 70 yrs [43/108] 39.4%; p < .05) and, less freque ntly, ventricular tachycardia/fibrillation (VT/VF) as a cause of CA. VT/VF bore the lowest immediate mortality rate (19/104; 18.3%) as compared with a systole/complete heart block (66/102; 64.7%) or pulseless electrical activi ty (40/49; 81.6%; p < .001). Acute myocardial infarction, acute heart failu re, hypotension, and occurrence of CA in the intensive care unit were also univariate predictors of unfavorable, immediate prognosis. However, in a mu ltiple logistic analysis model, the mechanism of GA (asystole/complete hear t block or pulseless electrical activity vs. VT/VF), acute myocardial infar ction, heart failure, and hypotension were independent predictors of unfavo rable immediate prognosis, whereas advancing age was not. Similarly, after initially successful CPR, short-term survival was independently associated with acute myocardial infarction, hypotension before GA, initial rhythm at CA, and need for mechanical ventilatory support after CPR, but not with age . Longterm survival (42 patients; 17.2% of the original cohort; median surv ival, 32 months) was also independent of age, whereas it was negatively ass ociated with heart failure. Conclusion: Immediate, short- and long-term prognosis after inhospital CPR is independent of age, at least when possible confounders are simultaneousl y taken into account.