Abstract 266: Impact Of Bystander-patient Relationship On Neurological Outcome In Witnessed Elderly Patients With Out-of-hospital Cardiac Arrest According To Age: A Nationwide Population-based Observational Study

Abstract

Introduction: Elderly patients with out-of-hospital cardiac arrest (OHCA) witnessed by a family member were associated with worse neurological outcome than those witnessed by a non-family bystander. Hypothesis: Impact of bystander-patient relationship (family member or non-family bystander) on neurological outcome in witnessed elderly OHCA patients could differ based on age. Methods: We evaluated 13,773 bystander-witnessed elderly OHCA patients (age ≥ 65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC). Data were obtained from the prospectively recorded All-Japan Utstein-style Registry between 2011 and 2016. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1 or 2. Patients were divided into three groups by age (65-74, 75-89, and ≥ 90 years). Results: The rates of 1-month CPC 1-2 and the frequencies of bystander-initiated cardiopulmonary resuscitation (BCPR) were significantly higher in patients witnessed by a non-family bystander [27.4% (1,360/4,971) and 68.5% (3,407/4,971)] than in those witnessed by a family member [19.7% (1,736/8,802) and 44.8% (3,942/8,802)] (p < 0.001, respectively). The rates of 1-month CPC 1-2 in patients aged 65-74, 75-89, and ≥ 90 years decreased with advancing age, 36.2% (1,733/4,788), 16.9% (1,264/7,469), and 6.5% (99/1,516), respectively (p for trend < 0.001). The rates of 1-month CPC 1-2 were significantly higher in patients witnessed by a non-family bystander than in those witnessed by a family member in those aged 65-74 years (45.0% and 30.9%) and 75-89 years (20.2% and 15.3%) (p < 0.001, respectively), but not in those aged ≥ 90 years (6.4% and 6.7%, p = 0.83). In multivariate logistic regression analysis adjusted for sex, initial rhythm, and time from call receipt to ROSC, witness by a non-family bystander and BCPR were significantly associated with 1-month CPC 1-2 for patients aged 65-74 years (adjusted odds ratio: 1.37 and 1.44, respectively; 95% confidence interval: 1.19-1.58 and 1.26-1.66, respectively), but not in those aged 75-89 and ≥ 90 years. Conclusions: Impact of bystander-patient relationship on neurological outcome in witnessed elderly OHCA patients varied with age.