Out-of-hospital cardiac arrests in older age groups

Abstract

Cardiopulmonary resuscitation (CPR) in elderly patients requires careful consideration. As the population ages and the burden of chronic diseases grow, paramedics will inevitably encounter, with greater frequency, out-of-hospital cardiac arrests (OHCA) in this population. Attitudes toward resuscitation in elders have shown to vary, based on the perceived likelihood of a successful outcome. Therefore, it is important that the paramedic has available age specific results on what the likelihood is of their patient, who they are deciding to resuscitate, achieving return of spontaneous circulation (ROSC) and, more importantly, surviving to leave hospital. Likewise, it is important for paramedics to understand OHCA outcomes when they are communicating with families of elderly victims of OHCA. Rates of survival to hospital discharge have recently been reported as 8% for those aged 65–79 years, 4% for octogenarians and 2% for nonagenarians. In patients aged 65 years or older, ROSC rates have improved for shockable and non-shockable rhythm OHCAs over the last decade, though survival to hospital discharge has improved in the shockable rhythm group only. Future research needs to address functional and quality of life outcomes for this age group and consider a community-wide approach to expected natural deaths occurring outside of hospital, so that inappropriate resuscitation efforts are avoided.