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The following is a summary of the study “Influences on the duration and success of out-of-hospital resuscitation of geriatric patients over 80 years of age – a retrospective evaluation,” published in the October 2024 issue of Emergency Medicine by Heuser et al.
As populations age, the number of resuscitation attempts in patients over 80 years has increased, with more than 34% of those resuscitated in Germany in 2022 being over 80. Advanced age is widely considered a poor predictor of successful cardiopulmonary resuscitation (CPR), and professional guidelines offer ethical recommendations for when resuscitation should be deemed futile.
So, for a study, researchers retrospectively analyzed the success and duration of out-of-hospital resuscitation (OHCA) in geriatric patients, evaluating how these ethical recommendations are implemented in practice. They reviewed pre-hospital resuscitation documentation from 578 cases involving patients aged 80 and older from 2014 to 2022, cross-referencing data from the German Resuscitation Registry. Statistical significance was determined at p < 0.05.
Key findings showed that 26% of patients (n = 148) achieved a return of spontaneous circulation (ROSC), while only 6.1% (n = 35) survived to discharge. The median CPR duration was 17 minutes. A strong inverse relationship between patient age and survival was observed (p = 0.05), with no patients over 90 years surviving. Additionally, poorer health status, as indicated by lower American Society of Anesthesiologists (ASA) scores, was associated with shorter resuscitation times (p < 0.001). Residents tended to perform CPR for longer durations compared to specialists (p = 0.02).
In patients who survived, shorter CPR durations were linked to better neurological outcomes. Patients with good cerebral performance (CPC 1/2) had a median resuscitation time of 5 minutes, while those with poorer neurological outcomes (CPC 3/4) had a median resuscitation time of 18 minutes (p = 0.01).
The team of researchers concluded that in patients over 80, older age and poorer health predict shorter resuscitation times and lower chances of survival. Quick identification and correction of reversible causes are crucial to improving ROSC and neurological outcomes. However, when these conditions cannot be met, resuscitation should be terminated promptly, particularly if it extends beyond 20 minutes, as survival after this point becomes highly unlikely.
Source: bmcemergmed.biomedcentral.com/articles/10.1186/s12873-024-01099-3
