Outcomes of Cardiopulmonary Resuscitation in the Elderly

TLDR

The study aims to assess CPR success rates in patients aged 70 years and older and to identify patient characteristics associated with effective CPR. A retrospective chart review of 503 consecutive elderly patients (≥70 years) who received CPR across five Boston health‑care institutions was conducted. Only 3.8 % of the 503 patients survived to hospital discharge, with 6.5 % survival for in‑hospital arrests and 0.8 % for out‑of‑hospital arrests; survival was lowest for unwitnessed arrests, asystole, and prolonged CPR, and higher among those with ventricular arrhythmias and early resuscitation.

Abstract

Study Objective: To determine the success rate of cardiopulmonary resuscitation in the elderly and to define characteristics of elderly patients for whom cardiopulmonary resuscitation is effective. Design: Retrospective chart review. Setting: Five Boston health-care institutions: two acute-care hospitals; two chronic-care hospitals; and one long-term-care institution. Patients: Five hundred and three consecutive patients aged 70 and over who received cardiopulmonary resuscitation. Measurements and Main Results: Of 503 patients, 112 (22%) survived initially but only 19 (3.8%) survived to hospital discharge. The poorest outcomes were for patients with unwitnessed arrests (1 of 116 survived), terminal arrhythmias such as asystole and electromechanical dissociation (1 of 237 survived), and patients with cardiopulmonary resuscitation lasting more than 15 minutes (1 of 360 survived). Only 2 (0.8%; CI, 0.0% to 2.0%) of 244 patients with out-of-hospital cardiopulmonary arrests left the hospital alive. Of 259 patients with in-hospital arrests, 17 (6.5%; CI, 3.4% to 9.6%) survived to discharge. Most survivors had ventricular arrhythmias and were resuscitated within minutes. Initial survivors with either impaired consciousness or functional impairment after the arrest had significantly worse chances of survival than patients without these impairments Conclusion: Cardiopulmonary resuscitation is rarely effective for elderly patients with cardiopulmonary arrests that are either out-of-hospital, unwitnessed, or associated with asystole or electromechanical dissociation.