Clinical outcomes and prognostic implications in super-elderly out-of-hospital cardiac arrest - a multicenter analysis

Background The rising prevalence of out-of-hospital cardiac arrest (OHCA) among super-elderly(≥80 years old) individuals represents a significant healthcare challenge in our aging society. Despite this demographic shift, comprehensive analyses of survival trajectories and neurological outcomes in this vulnerable population remain understudied. This investigation sought to elucidate the clinical outcomes and prognostic indicators following OHCA in octogenarians and beyond. Methods We orchestrated a multicenter retrospective observational study encompassing three tertiary care institutions - two university hospitals and one general hospital - spanning January 2015 through December 2021. The initial cohort comprised 2,374 OHCA patients, from which we excluded 695 cases where do-not-resuscitate orders were implemented during cardiopulmonary resuscitation and 43 pediatric cases (age <19 years), yielding a final analytical sample of 1,636 patients. We established a hierarchical outcome framework: primary (return of spontaneous circulation; ROSC), secondary (survival to discharge), and tertiary (favorable neurological outcome). Results Among the study population, ROSC was achieved in 451 cases (median age 71 years, range 19-98), with 80 patients surviving to discharge (median age 57 years, range 22-92), and 42 demonstrating favorable neurological outcomes (median age 52 years, range 29-92). Within the super-elderly subgroup (n=560), we observed 145 instances of ROSC, 11 survival-to-discharge cases, and 3 patients with favorable neurological outcomes. Statistical analyses revealed no significant disparity in ROSC rates between age cohorts (p=0.301); however, marked differences emerged in survival to discharge (p<0.001) and favorable neurological outcomes (p=0.029). Multivariate logistic regression analysis yielded odds ratios for the super-elderly cohort of 0.550 (95% CI 0.417-0.725) for ROSC, 0.296 (95% CI 0.147-0.596) for survival to discharge, and 0.189 (95% CI 0.041-0.860) for favorable neurological outcomes. Conclusion Our findings illuminate a nuanced reality in super-elderly OHCA patients: while demonstrating comparable ROSC rates to their younger counterparts, they exhibit substantially diminished probabilities of survival to discharge and favorable neurological outcomes. Nevertheless, the documented instances of favorable neurological recovery in this demographic advocate against age-singular termination of resuscitation protocols. These observations underscore the imperative for developing sophisticated, multi-parametric decision-making frameworks that transcend chronological age in guiding resuscitation efforts for super-elderly cardiac arrest patients. Future research trajectories should focus on identifying and validating comprehensive prognostic indicators to optimize resource allocation and enhance outcome prediction in this growing patient population.