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Age-specific prognostication after out-of-hospital cardiac arrest – The ethical dilemma between ‘life-sustaining treatment’ and ‘the right to die’ in the elderly

2016; Oxford University Press; Volume: 6; Issue: 2 Linguagem: Inglês

10.1177/2048872616672076

2048-8734

Patrick Sulzgruber, Fritz Sterz, Michael Poppe, Andreas Schober, Elisabeth Lobmeyr, Philip Datler, Markus Keferböck, Sebastian Zeiner, Alexander Nürnberger, Pia Hubner, Peter Stratil, Christian Wallmueller, Christoph Weiser, Alexandra-Maria Warenits, Raphael van Tulder, Andreas Zajicek, Angelika Buchinger, Christoph Testori,

Trauma and Emergency Care Studies

While prognostic values on survival after out-of-hospital cardiac arrest have been well investigated, less attention has been paid to their age-specific relevance. Therefore, we aimed to identify suitable age-specific early prognostication in elderly patients suffering out-of-hospital cardiac arrest in order to reduce the burden of unnecessary treatment and harm.In a prospective population-based observational trial on individuals suffering out-of-hospital cardiac arrest, a total of 2223 patients receiving resuscitation attempts by the local emergency medical service in Vienna, Austria, were enrolled. Patients were stratified according to age as follows: young and middle-aged individuals ( 85 years).There was an increasing rate of 30-day mortality (+21.8%, p < 0.001) and unfavourable neurological outcome (+18.8%, p < 0.001) with increasing age among age groups. Established predictive variables lost their prognostic potential with increasing age, even after adjusting for potential confounders. Independently, an initially shockable electrocardiogram proved to be directly associated with survival, with an adjusted hazard ratio (HR) of 2.04 (95% confidence interval (CI) 1.89-2.38, p = 0.003) for >85-year-olds. Frailty was directly associated with mortality (HR 1.22, 95% CI 1.01-1.51, p = 0.049), showing a 30-day survival of 5.6% and a favourable neurological outcome of 1.1% among elderly individuals.An initially shockable electrocardiogram proved to be a suitable tool for risk assessment and decision making in order to predict a successful outcome in elderly victims of out-of-hospital cardiac arrest. However, the outcomes of elderly patients seemed to be exceptionally poor in frail individuals and need to be considered in order to reduce unnecessary treatment decisions.