Geriatric Experience Following Cardiac Arrest at Six Interventional Cardiology Centers in the United States 2006-2011: Interplay of Age, Do-Not-Resuscitate Order, and Outcomes
Geriatric Experience Following Cardiac Arrest at Six Interventional Cardiology Centers in the United States 2006-2011: Interplay of Age, Do-Not-Resuscitate Order, and Outcomes
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DOI：
10.1097/ccm.0b013e3182a26ec6
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发表时间：
2014-02-01
影响因子：
8.8
通讯作者：
Mooney, Michael
中科院分区：
文献类型：
--
作者：
Seder, David B.;Patel, Nainesh;Mooney, Michael
目的：目前尚不清楚积极的复苏后护理，包括治疗性低温和经皮冠状动脉介入治疗，是否对75岁以上的心脏骤停幸存者有益。我们比较了美国六个地区性经皮冠状动脉介入治疗中心的患者的治疗和结果，以确定老年患者是否需要积极的护理。设计：回顾性评估登记数据。设置：美国六个介入心脏病中心。患者：625名年龄在18-75岁之间的无反应心脏骤停幸存者与129名年龄超过75岁的类似患者进行了比较。无。测量和主要结果：年龄超过75岁的心脏骤停幸存者有更多的合并症（3.0 ± 1.6 vs 2.0 ± 1.6，p < 0.001），但在初始心律、见证骤停、旁观者心肺复苏和总缺血时间方面与年轻患者相匹配。75岁以上的患者经常接受治疗性低温（97.7%）、紧急冠状动脉造影（44.2%）和紧急经皮冠状动脉介入治疗（24%）。他们有更持久的高血糖（70.5%对59%，p = 0.015），更少的冷却后发热（25.2%对35.2%，p = 0.03），更可能有不复苏命令（65.9%对48.2%，p < 0.001），并经历生命支持的撤回（61.2%对47.5%，p = 0.005）。总体而言，27.9%的老年患者与40.4%的年轻患者（p = 0.01）以及44%与55%（p = 0.13）的初始可电击心律患者在6个月时观察到良好的功能结局（脑功能分类1-2）。在35名75岁以上的幸存者中，33名（94.8%）在（平均）6.5个月随访时被归类为脑功能1级或2级。在多变量logistic回归模型，年龄超过75岁显着相关的结果，只有当存在的不复苏订单被排除在model.Conclusions：老年患者更有可能有不复苏订单，并进行撤回生命支持。只有排除不复苏状态的校正后，年龄才与预后独立相关，老年幸存者的功能预后与年轻患者相似。将75岁以上的患者排除在积极治疗之外并不是仅仅基于年龄。
Objectives: It is not known if aggressive postresuscitation care, including therapeutic hypothermia and percutaneous coronary intervention, benefits cardiac arrest survivors more than 75 years old. We compared treatments and outcomes of patients at six regional percutaneous coronary intervention centers in the United States to determine if aggressive care of elderly patients was warranted.Design: Retrospective evaluation of registry data.Setting: Six interventional cardiology centers in the United States.Patients: Six hundred and twenty-five unresponsive cardiac arrest survivors aged 18-75 were compared with 129 similar patients aged more than 75.Interventions: None.Measurements and Main Results: Cardiac arrest survivors aged more than 75 had more comorbidities (3.0 1.6 vs 2.0 +/- 1.6, p < 0.001), but were matched to younger patients in initial heart rhythm, witnessed arrests, bystander cardiopulmonary resuscitation, and total ischemic time. Patients aged more than 75 frequently underwent therapeutic hypothermia (97.7%), urgent coronary angiography (44.2%), and urgent percutaneous coronary intervention (24%). They had more sustained hyperglycemia (70.5% vs 59%, p = 0.015), less postcooling fever (25.2% vs 35.2%, p = 0.03), were more likely to have do-not-resuscitate orders (65.9% vs 48.2%, p < 0.001), and undergo withdrawal of life support (61.2% vs 47.5%, p = 0.005). Good functional outcome at 6 months (Cerebral Performance Category 1-2) was seen in 27.9% elderly versus 40.4% younger patients overall (p = 0.01) and in 44% versus 55% (p = 0.13) of patients with an initial shockable rhythm. Of 35 survivors more than 75 years old, 33 (94.8%) were classified as Cerebral Performance Category 1 or 2 at (mean) 6.5-month follow-up. In multivariable logistic regression modeling, age more than 75 was significantly associated with outcome only when the presence of a do-not-resuscitate order was excluded from the model.Conclusions: Elderly patients were more likely to have do-not-resuscitate orders and to undergo withdrawal of life support. Age was independently associated with outcome only when correction for do-not-resuscitate status was excluded, and functional outcomes of elderly survivors were similar to younger patients. Exclusion of patients more than 75 years old from aggressive care is not warranted on the basis of age alone.