Cardiac arrest: increasing age, in-hospital arrest, long CPR time, long total arrest time, history of diabetes or congestive heart failure, or noncardiac arrest increased the risk of dying.

Clinical bottom line (level 2b)

  1. Three-quarters of patients who had a cardiac arrest and were revived to only an unconscious state died within 6 months.
  2. Patients were at increased risk of dying within 6 months following a cardiac arrest if they were aged more than 45 years, had an in-hospital cardiac arrest, had CPR for more than 20 minutes, had a total arrest time of more than 5 minutes, history of diabetes, history of congestive heart failure, primary arrest was noncardiac
Rogove et al: Critical Care Medicine 1995; 23: 18-25
Expires October 2003

The study

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

Setting: 12 hospitals in 9 countries

778 patients (aged range <45 to >81 years, 66% male) no purposeful motor response to pain after resuscitation from cardiac arrest

Excluded if
  • cardiac arrest due to primary intracranial disease
  • coma caused by central nervous system-depressant drugs
  • arrest with accompanying hypothermia
  • resuscitation efforts inappropriate (hopeless terminal conditions and who had been designated 'do not resuscitate')



    • Factors studied:
  • death
  • age 46 to 65 years compared with < or = 45 years
  • age 66 to 80 years compared with age < or = 45 years
  • age > 80 years compared with age < or = 45 years
  • in-hospital arrest
  • CPR time >20 minutes
  • total arrest time > 5 minutes
  • history of diabetes
  • history of congestive heart failure
  • primary cause of arrest noncardiac


    • High-dose thiopental or lidoflazine, or placebo was given to patients.

    Multivariate analysis performed using the Cox proportional hazards model was used to adjust for confounding factors.

    93% followed for 6 months
    Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death 6 months 627/774 81.01%
    (78.24% to 83.77%)

    prognostic factor for
    death     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    age 46 to 65 years 6 months 0.57
    (1.19 to 2.08)     		5
    (2 to 14)
    age 66 to 80 years 6 months 1.66
    (1.26 to 2.18)     		4
    (2 to 10)
    age > 80 years 6 months 2.09
    (1.40 to 3.11)     		14
    (7 to 39)
    in-hospital arrest 6 months 1.50
    (1.22 to 1.82)     		6
    (4 to 14)
    CPR time >20 minutes 6 months 1.74
    (1.47 to 2.06)     		3
    (2 to 5)
    total arrest time > 5 minutes 6 months 1.36
    (1.12 to 1.64)     		9
    (5 to 26)
    history of diabetes 6 months 1.38
    (1.12 to 1.70)     		15
    (8 to 46)
    history of congestive heart failure 6 months 1.37
    (1.14 to 1.64)     		9
    (5 to 25)
    primary cause of arrest noncardiac 6 months 1.41
    (1.16 to 1.71)     		8
    (5 to 21)

    Comments

    1. Study is a re-analysis of data from an RCT, and may reflect idiosyncrasies of the data set.

    Citation

    1. Rogove HJ, Safar P, Sutton-Tyrrell K, et al: Old age does not negate good cerebral outcome after cardiopulmonary resuscitation: Analyses from the brain resuscitation clinical trials. Critical Care Medicine 1995; 23: 18-25
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer: Luis Ruiz Del Fresno

    Clinical Question.
    Patient cardiac arrest
    Intervention or Exposure old age
    Comparison not old age
    Outcome mortality