Key result
Younger age was associated with the largest temporal increase in 30-day survival (5.8% to 22.0%, P<0.001), and patients lacking prehospital shock and ROSC had minimal survival (3 of 9,499).
Why the study?
Does age impact temporal changes in survival after out-of-hospital cardiac arrest, and can patients with minimal chance of 30-day survival be identified early?
Cohort (n=21,480)
Yes
Does age impact temporal changes in survival after out-of-hospital cardiac arrest, and can patients with minimal chance of 30-day survival be identified early?
Answers are grounded in this paper and cite their sources.
Survival after out-of-hospital cardiac arrest has improved significantly over time, particularly in younger patients, and patients with minimal chance of survival can be identified by the absence of both prehospital shock and ROSC on hospital arrival.
BACKGROUND: Survival after out-of-hospital cardiac arrest has increased during the last decade in Denmark. We aimed to study the impact of age on changes in survival and whether it was possible to identify patients with minimal chance of 30-day survival. METHODS AND RESULTS: Using data from the nationwide Danish Cardiac Arrest Registry (2001─2011), we identified 21 480 patients ≥18 years old with a presumed cardiac-caused out-of-hospital cardiac arrest for which resuscitation was attempted. Patients were divided into 3 preselected age-groups: working-age patients 18 to 65 years of age (33.7%), early senior patients 66 to 80 years of age (41.5%), and late senior patients >80 years of age (24.8%). Characteristics in working-age patients, early senior patients, and late senior patients were as follows: witnessed arrest in 53.8%, 51.1%, and 52.1%; bystander cardiopulmonary resuscitation in 44.7%, 30.3%, and 23.4%; and prehospital shock from a defibrillator in 54.7%, 45.0%, and 33.8% (all P<0.05). Between 2001 and 2011, return of spontaneous circulation on hospital arrival increased: working-age patients, from 12.1% to 34.6%; early senior patients, from 6.4% to 21.5%; and late senior patients, from 4.0% to 15.0% (all P<0.001). Furthermore, 30-day survival increased: working-age patients, 5.8% to 22.0% (P<0.001); and early senior patients, 2.7% to 8.4% (P<0.001), whereas late senior patients experienced only a minor increase (1.5% to 2.0%; P=0.01). Overall, 3 of 9499 patients achieved 30-day survival if they met 2 criteria: had not achieved return of spontaneous circulation on hospital arrival and had not received a prehospital shock from a defibrillator. CONCLUSIONS: All age groups experienced a large temporal increase in survival on hospital arrival, but the increase in 30-day survival was most prominent in the young. With the use of only 2 criteria, it was possible to identify patients with a minimal chance of 30-day survival.
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Wissenberg et al. (2015) conducted a cohort in Out-of-hospital cardiac arrest (n=21,480). Younger age vs. Older age was evaluated on 30-day survival. Younger age was associated with the largest temporal increase in 30-day survival (5.8% to 22.0%, P<0.001), and patients lacking prehospital shock and ROSC had minimal survival (3 of 9,499).
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