Prehospital predictors of neurological outcomes in out-of-hospital cardiac arrest patients aged 95 years and older: A nationwide population-based observational study

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• 作者：Akira Funada ; MD ; PhD^a ; ^b ; Yoshikazu Goto ; MD ; PhD^a ; ^{gotoyosh@med.kanazawa-u.ac.jp} ; Tetsuo Maeda ; MD ; PhD^a ; Hayato Tada ; MD ; PhD^a ; ^b ; Ryota Teramoto ; MD^a ; ^b ; Yoshihiro Tanaka ; MD^a ; ^b ; Kenshi Hayashi ; MD ; PhD ; FJCC^b ; Masakazu Yamagishi ; MD ; PhD ; FJCC^b
• 关键词：Out-of-hospital cardiac arrest ; Cardiopulmonary resuscitation ; Elderly ; Medical futility ; Epidemiology
• 刊名：Journal of Cardiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：69
• 期：1
• 页码：340-344
• 全文大小：543 K
• 卷排序：69

文摘

Population aging has rapidly progressed in Japan. However, few data exist regarding the characteristics of extremely elderly patients with out-of-hospital cardiac arrest (OHCA). We aimed to determine the prehospital predictors of one-month survival with favorable neurological outcomes (Cerebral Performance Category scale, category 1 or 2; CPC 1–2) in this population.MethodsWe investigated 23,520 OHCA patients aged ≥95 years from a prospectively recorded, nationwide, Utstein-style Japanese database between 2008 and 2012. The primary study endpoint was one-month CPC 1–2 after OHCA.ResultsThe one-month CPC 1–2 rate was 0.27% (63/23,520). Only two variables were significantly associated with one-month CPC 1–2 in a multivariate logistic regression model: prehospital return of spontaneous circulation (ROSC) [adjusted odds ratio (aOR), 94.4; 95% confidential interval (CI), 50.1–191.7] and emergency medical service (EMS)-witnessed arrest (aOR, 5.1; 95% CI, 2.6–10.2). When stratified by these two predictors, the one-month CPC 1–2 rates were 20.2% (18/89) for patients who had both prehospital ROSC and EMS-witnessed arrest, 4.2% (33/783) for those who had prehospital ROSC without EMS-witnessed arrest, 0.28% (3/1065) for those who had EMS-witnessed arrest without prehospital ROSC, and 0.04% (9/21,583) for those who had neither predictor, respectively.ConclusionsThe crucial prehospital predictors for one-month CPC 1–2 in elderly OHCA patients aged ≥95 years in Japan were prehospital ROSC and EMS-witnessed arrest and the former was the predominant predictor.