Clinical Outcomes and Applicability of Emergency Department Termination-of-Resuscitation Rules in Super-Elderly Patients with Out-of-Hospital Cardiac Arrest: A Multicenter Analysis

Introduction: The global aging population has led to a rapid increase in patients aged ≥ 80 years experiencing out-of-hospital cardiac arrest (OHCA). This study used data from three domestic university hospitals to analyze the clinical characteristics and prognoses of elderly patients and evaluate the validity of age-based criteria for termination of resuscitation (TOR). Methods: This study included 1234 adult patients with nontraumatic OHCA who presented to the emergency departments of three hospitals between 2015 and 2021. The patients were categorized as non-elderly (<65 years), elderly (65–79 years), or super-elderly (≥80 years), and outcomes, including return of spontaneous circulation (ROSC), survival to discharge, and favorable neurological outcomes (Cerebral Performance Category 1–2), were analyzed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) with Wilson 95% confidence intervals (CIs), and the area under the ROC curve (AUC) of the W−/D−/R− (unwitnessed/non-shockable/no prehospital ROSC) rule were calculated for both the full cohort and the super-elderly subgroup. Results: The super-elderly patients (n = 466) had significantly lower rates of ROSC, survival to discharge, and favorable neurological outcomes than the other age groups. Multivariate analysis revealed that extreme old age was a strong negative predictor of favorable neurological outcomes. For super-elderly patients as a whole (n = 466), the survival rate was only 2.4%, and the favorable neurological outcome rate was only 0.6%. Conclusions: Although the prognosis for super-elderly patients with OHCA is extremely poor, the possibility of survival is not entirely “zero.” Therefore, applying a multifactorial ED TOR rule that comprehensively considers whether the arrest was witnessed, the initial rhythm, and whether on-scene ROSC occurred, rather than relying solely on age criteria, would be more rational and aid in ethical decision-making.