https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Köln Herzzentrum - Kardiologie Köln, Deutschland; 2Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 3Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 4Universitätsmedizin der Johannes Gutenberg-Universität Mainz Zentrum für Kardiologie Mainz, Deutschland; 5Klinikum Leverkusen Klinik für Akut- und Notfallmedizin Leverkusen, Deutschland; 6Universitätsklinikum Köln Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland
Background: In an increasingly aging population, there is still a need for studies investigating preclinical and in-hospital treatment as well as outcomes and prognosticators for survival of elderly out of hospital cardiac arrest (OHCA) victims.
Aim: The aim of this study was to evaluate differences in elderly OHCA survivors vs non-survivors.
Methods: A registry including non-traumatic OHCA admitted to a metropolitan University Hospital from 2014-2022 was analyzed. Eligible patients were stratified into groups according to age (Figure): Patients over the age of 80 years were defined as elderly. Survival to discharge was analyzed. Elderly survivors were compared to non-survivors. Data was analyzed using Chi-Square-Test and Kruskal-Willis-Test with Bonferroni-Corrections for multiple comparisons were appropriate. A p-value of < 0.05 was regarded significant.
Results: 472 patients were identified with an overall median age of 64 years, 24% females and a bystander CPR rate of 57%. There were 11% (n=50) elderly patients (Range 81 to 91 years). The Return of spontaneous circulation (ROSC) on-scene was significantly more often observed in elderly (90%) compared to younger patients (49-66%, p<0.001). Young and middle aged significantly more often survived to discharge compared to the elderly (57 and 54.5% vs 28%, p<0.007). While having a similar median age (84 years) and median no-flow time (2 minutes) elderly survivors had tendencies of more initial shockable rhythms (50% vs 33%), more witnessed arrests (86% vs 67%) and more cardiac causes (78% vs 64%) compared to non-survivors. Elderly survivors mostly had acute myocardial infarction as a documented cardiac cause followed by primary arrhythmia (Ventricular fibrillation and atrioventricular blocks). All elderly survivors had a ROSC on-scene. Only 4 elderlies were discharged to home, the others were discharged to rehabilitations facilities. Of the elderly survivors 8 had a documented Cerebral Performance Category (CPC) score of 1, 3 survivors had a CPC of 2. No case of severe hypoxic ischemic encephalopathy was documented.
Conclusion: In this highly selected population of OHCA victims admitted to a cardiac arrest center with presumed cardiac cause of arrest, elderly patients had a survival to hospital discharge of 28%. The elderly survivors more often had a ROSC on-scene and cardiac causes like myocardial infarction and initial shockable rhythms, which were regarded as favorable factors. While 1 in 4 of the elderly survived to hospital discharge, only a minority was discharged to home with good neurological outcomes. With increasing rates of elderly in the population, further studies should evaluate the role of favorable factors in treatment, prognostication and when discussing limits of treatment of elderly OHCA survivors.