Out-of-hospital cardiac arrests in the older age groups in Melbourne, Australia

Abstract

Background Controversy exists around CPR in the elderly. The characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in this age group were studied in Melbourne, Australia. Methods The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for all OHCAs not witnessed by Emergency Medical Services (EMS) occurring in those aged 65 years and older. Results Between 2000 and 2009 there were 30,006 OHCAs of which 9703 (32%) were in people 65–79 years of age, 6430 (21%) in octogenarians, 1530 (5%) in nonagenarian and 40 (0.1%) in centenarians. Rates of attempted resuscitation decreased with advancing age: 48% for those aged 65–79 years, 39% for octogenarians, 31% for nonagenarians and 17% for centenarians. Similarly rates of survival to hospital discharge decreased with age: 8% for those aged 65–79 years, 4% for octogenarians, 2% for nonagenarians; for 65–79 year olds, octogenarians and nonagenarians survival if in VF/VT was – 17%, 10% and 4%; asystole – 1%, 1% and 0.5%; and PEA – 6%, 3% and 3%, respectively. Multivariable logistic regression shows that between 2000 and 2009 rates of transportation with return of spontaneous circulation have improved for both shockable and non-shockable rhythms [OR 95% CI 1.07(1.04–1.10) and 1.16(1.12–1.20), respectively] but survival to hospital discharge has improved in the shockable rhythm group only [OR 1.12(1.07–1.16)]. Conclusion Outcomes for OHCA with shockable rhythm have improved over the last 10 years for people aged 65 years and over. Quality of life studies should be performed to help inform the community and EMS on appropriate resuscitative efforts.