Abstract 23: Geriatric Experience Following Cardiac Arrest at 6 Interventional Cardiology Centers in the United States, 2007-2011

Abstract

Background: It is unknown if aggressive techniques such as therapeutic hypothermia (TH) and percutaneous coronary intervention (PCI) benefit cardiac arrest (CA) survivors over 75 years old. We evaluated the experiences of these patients at six regional PCI centers in the United States. Methods: Demographics, hospital course, adverse events, treatments, and outcomes of 542 cardiac arrest survivors aged 18-75 were compared to 122 similar patients aged >76. These data were retrospectively and prospectively entered into a secure, web-based registry (INTCAR). Findings: Cardiac arrest survivors aged >75 frequently underwent TH (98%), urgent coronary angiography (36.9%), and urgent PCI (24%) - rates similar to younger patients. Elderly patients had more comorbidities (3.0 +1.6 vs. 2.1+1.6, P<0.001), worse presenting left ventricular ejection fraction, and shorter time to return of spontaneous circulation (20.4+13.1 vs. 24.2+16.9 minutes, P=0.029). Pneumonia occurred more often among the elderly (32.8% v 23.8%, P=0.04), who also trended toward more sustained hyperglycemia (73% vs 64.4%, P=0.07) and less post-cooling fever (24% vs 32.7%, P=0.06). There were no differences in bleeding, seizures, electrolyte disturbances, arrhythmias, or most other adverse events. Brain MRI was not performed in any patient >75. Elderly patients were more likely to have DNR orders (66.4% vs 50.3%, P=0.001) and to undergo termination of life support (63.1% vs 49.4%, P=0.006). Good neurological outcome at 6-months (CPC 1-2) was seen in 27.9% elderly patients and 40.4% younger patients (P=0.01), and in 44% vs 55%, (P=0.13) of the subgroup presenting with VT/VF. Of 6-month survivors, 4% elderly patients remained severely disabled or vegetative, and 69% were classified as CPC 1. Conclusions: Patients over 75 years old were less likely to have a good neurological outcome at 6 months after cardiac arrest, but exclusion of elderly patients from standard post-resuscitation care is not warranted on the basis of age alone.