Cardiac arrest: elderly: survival was best from witnessed in-hospital arrest.

Clinical bottom line (level 2b)

  1. One in four elderly patients were successfully resuscitated following a cardiac arrest, though only 4% left hospital alive.
  2. Few patients who had an out-of-hospital arrest left hospital alive.
  3. Few patients who had an asystolic or PEA arrest left hospital alive.
  4. Few patients who had an unwitnessed arrest left hospital alive.
Murphy et al: Annals of Internal Medicine 1989; 111 (3): 199-205
Expires October 2003

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: three acute hospitals and two chronic-care hospitals, USA

503 patients (aged aged > 69 (40% > 80), ?% male) who received cardiopulmonary resuscitation

Excluded if
  • syncope, seizure, airway obstruction from food aspiration or progressive respiratory failure leading to elective intubation



    • Factors studied:
  • age, sex, functional status, mental status, previous disease, current medication, details of arrest (length, witnessed, time to recovery)




    • Multivariate regression analysis performed on prognostic factors.

    ?100% followed for to discharge
    Outcomes studied:
  • successful resuscitation
  • discharged alive from hospital
  • successful resuscitation of out-of-hospital arrest
  • discharged alive following out-of-hospital arrest
  • successful resuscitation of in-hospital arrest
  • discharged alive following in-hospital arrest
  • survival to discharge following unwitnessed arrest
  • survival to discharge following asystole or pulseless electrical activity

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    successful resuscitation to discharge 112/503 22%
    (19% to 26%)    		 4
    (4 to 5)
    discharged alive from hospital to discharge 19/503 3.8%
    (2.1% to 5.4%)    		 26
    (18 to 47)
    successful resuscitation of out-of-hospital arrest to discharge 20/244 8.2%
    (4.8% to 12%)    		 12
    (9 to 21)
    discharged alive following out-of-hospital arrest to discharge 2/244 0.82%
    (0.1% to 3.2%)    		 120
    (31 to 1000)
    successful resuscitation of in-hospital arrest to discharge 92/259 36%
    (30% to 41%)    		 3
    (2 to 3)
    discharged alive following in-hospital arrest to discharge 17/259 6.6%
    (3.5% to 9.6%)    		 15
    (10 to 28)
    survival to discharge following unwitnessed arrest to discharge 1/116 0.9%
    (0.002% to 4.7%)    		 116
    (21 to 4500)
    survival to discharge following asystole or pulseless electrical activity to discharge 1/237 0.4%
    (0.001% to 2.3%)    		 240
    (43 to 9400)

    • The following prognostic factors predicted survival to discharge
      • few acute illnesses before arrest
      • short duration of chest massage during resuscitation
      • level of consciousness after arrest

    Citation

    1. Murphy DJ, Murray AM, Robinson BE, et al: Outcomes of cardiopulmonary resuscitation in the elderly. Annals of Internal Medicine 1989; 111 (3): 199-205
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient elderly
    Intervention or Exposure cardiac arrest
    Outcome survival