Abstract 250: The Association of Advanced Age and Outcomes in Targeted Temperature Management After Out-of-hospital Cardiac Arrest

Abstract

Background: Therapeutic hypothermia or targeted temperature management (TTM) is the only therapy shown to improve neurologically intact survival post cardiac arrest. One of the original randomized control trials evaluating TTM, excluded patients older than 75. Advanced age has been associated with poor outcomes following cardiac arrest. However, investigations have shown that elderly patients that actually survive cardiac arrest may go on to have good outcomes. Given these findings it is unclear whether TTM benefits elderly patients. Objectives: We hypothesized that in patients undergoing TTM, advanced age would be associated with decreased survival to discharge as well as decreased neurologically intact survival. Methods: We performed a retrospective single center study of 140 patients who underwent TTM after cardiac arrest over a four-year period. Patients were analyzed based on advanced age defined as age greater than or equal to 80. The primary outcomes were survival to discharge and neurologically intact survival defined as a CPC score of 1 or 2. We compared baseline characteristics including: initial lactate, witnessed arrest, down time, initial cardiac rhythm, bystander CPR and vasopressor use. Results: A total of 140 patients underwent TTM (12 patients with advanced age vs. 128). Fewer patients survived in the advanced age group (8.3% vs. 43% p =0.01), and fewer survived with good neurologic function (8.3% vs. 35.9% p = 0.03). Baseline characteristics were similar except for a lower proportion of VF/VT in the advanced age group (16.7% vs. 52.8% p=0.01). After adjusting for these characteristics, advanced age was still associated with decreased survival (p = 0.04), but not with decreased neurologically intact survival (p =0.15). When age greater than or equal to 75 years was chosen as the cut off for advanced age, survival to discharge was 17.4 % (4/23) with all survivors having good neurologic function. Conclusions: Age greater than 80 was associated with decreased survival to discharge but not with decreased neurologically intact survival. Additionally, all of the survivors 75 or older had good neurologic outcomes. Further study is needed to establish the benefits of TTM in the elderly.