Long-term outcome of elderly out-of-hospital cardiac arrest survivors as compared with their younger counterparts and the general population

Hiemstra, Bart; Bergman, Remco; Absalom, Anthony; Naalt, Joukje van der; Harst, Pim van der; Vos, Ronald de; Nieuwland, Wybe; Nijsten, Maarten W. N.; Horst, Iwan C. C. van der

doi:10.1177/1753944718792420

Cited by 24 publications

(27 citation statements)

References 53 publications

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“…As long term prognosis of OHCA survivors is essentially determined by their neurological status, an early assessment is crucial to predict an unfavorable course with poor neurological outcome [ 22 ]. Anoxic brain injury is the leading neurological cause of death following OHCA rather than brain death, which accounts for only about 10% of causes [ 19 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Neuromarkers and neurological outcome in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia–experience from the HAnnover COoling REgistry (HACORE)

et al. 2021

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Background Neuron-specific enolase (NSE) and S-100b have been used to assess neurological damage following out-of-hospital cardiac arrest (OHCA). Cut-offs were derived from small normothermic cohorts. Whether similar cut-offs apply to patients treated with hypothermia remained undetermined. Methods We investigated 251 patients with OHCA treated with hypothermia but without routine prognostication. Neuromarkers were determined at day 3, neurological outcome was assessed after hospital discharge by cerebral performance category (CPC). Results Good neurological outcome (CPC≤2) was achieved in 41%. Elevated neuromarkers, older age and absence of ST-segment elevation after ROSC were associated with increased mortality. Poor neurological outcome in survivors was additionally associated with history of cerebrovascular events, sepsis and higher admission lactate. Mean NSE was 33μg/l [16–94] vs. 119μg/l [25–406]; p<0.001, for survivors vs. non-survivors, and 21μg/l [16–29] vs. 40μg/l [23–98], p<0.001 for good vs. poor neurological outcome. S-100b was 0.127μg/l [0.063–0.360] vs. 0.772μg/l [0.121–2.710], p<0.001 and 0.086μg/l [0.061–0.122] vs. 0.138μg/l [0.090–0.271], p = 0.009, respectively. For mortality, thresholds of 36μg/l for NSE and 0.128μg/l for S-100b could be determined; for poor neurological outcome 33μg/l (NSE) and 0.123μg/l (S-100b), respectively. Positive predictive value for NSE was 81% (74–88) and 79% (71–85) for S-100b. Conclusions Thresholds for NSE and S-100b predicting mortality and poor neurological outcome are similar in OHCA patients receiving therapeutic hypothermia as in those reported before the era of hypothermia. However, both biomarkers do not have enough specificity to predict mortality or poor neurological outcome on their own and should only be additively used in clinical decision making.

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Section: Discussionmentioning

confidence: 99%

Neuromarkers and neurological outcome in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia–experience from the HAnnover COoling REgistry (HACORE)

et al. 2021

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“…A survival rate that corresponds to that of the general population has been reported in elderly patients surviving to hospital discharge after out-of-hospital cardiac arrest (OHCA), whereas elderly patients with severe traumatic brain injury are characterised by overmortality. 10 11 …”

Section: Introductionmentioning

confidence: 99%

Short-term and long-term survival in critical patients treated by helicopter emergency medical services in Finland: a registry study of 36 715 patients

et al. 2021

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ObjectivesThis study aimed to describe the short-term and long-term mortality of patients treated by prehospital critical care teams in Finland.Design and settingWe performed a registry-based retrospective study that included all helicopter emergency medical service (HEMS) dispatches in Finland from 1 January 2012 to 8 September 2019. Mortality data were acquired from the national Population Register Centre to calculate the standardised mortality ratio (SMR).ParticipantsAll patients encountered by Finnish HEMS crews during the study period were included.Main outcomesMortalities presented at 0 to 1 day, 2 to 30 days, 31 days to 1 year and 1 to 3 years for different medical reasons following the prehospital care. Patients were divided into four groups by age and categorised by gender. The SMR at 2 to 30 days, 31 days to 1 year and 1 to 3 years was calculated for the same groups.ResultsPrehospital critical care teams participated in the treatment of 36 715 patients, 34 370 of whom were included in the study. The cumulative all-cause mortality at 30 days was 27.5% and at 3 years was 36.5%. The SMR in different medical categories and periods ranged from 23.2 to 72.2, 18.1 to 22.4, 7.7 to 9.2 and 2.1 to 2.6 in the age groups of 0 to 17 years, 18 to 64 years, 65 to 79 years and ≥80 years, respectively.ConclusionsWe found that the rate of mortality after a HEMS team provides critical care is high and remains significantly elevated compared with the normal population for years after the incident. The mortality is dependent on the medical reason for care and the age of the patient. The long-term overmortality should be considered when evaluating the benefit of prehospital critical care in the different patient groups.

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“…Nonetheless, several studies and meta-analyses have shown that age negatively affects post-CA mortality [26]. Long-term survival among elderly CA patients is generally lower than that among younger age groups in the case of OHCA [27,28].…”

Section: Discussionmentioning

confidence: 99%

Intensive care–treated cardiac arrest: A retrospective study on the impact of extended age on mortality, neurological outcome, received treatments and healthcare-associated costs

Holmström

Efendijev

Raj

et al. 2021

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Background: Cardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital. Methods: This single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital’s ICU between 2005 and 2013. We stratified the study population into two age groups: <75 and 75 years. We compared interventions defined by the median daily therapeutic scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1–2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent association between age group, mortality and neurological outcome. Results: This study included a total of 1,285 patients, of which 212 (16%) were 75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p < 0.001). The effective cost in euros for patients with a good one-year neurological outcome was €168,000 for the elderly and €120,000 for the younger group. At 12 months after CA 24% of the patients in the elderly group and 47% of the patients in the younger group had a CPC of 1-2 (p < 0.001). Age was an independent predictor of mortality (multivariate OR = 3.36, 95% CI:2.21-5.11, p < 0.001) and neurological outcome (multivariate OR = 3.27, 95% CI: 2.12-5.03, p < 0.001). Conclusions: The elderly ICU-treated CA patients in this study had worse neurological outcomes, higher mortality and lower cost-effectiveness than younger patients. Further efforts are needed to recognize the tools for assessing which elderly patients benefit from a more aggressive treatment approach in order to improve the cost-effectiveness of post-CA management.

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Long-term outcome of elderly out-of-hospital cardiac arrest survivors as compared with their younger counterparts and the general population

Cited by 24 publications

References 53 publications

Neuromarkers and neurological outcome in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia–experience from the HAnnover COoling REgistry (HACORE)

Neuromarkers and neurological outcome in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia–experience from the HAnnover COoling REgistry (HACORE)

Short-term and long-term survival in critical patients treated by helicopter emergency medical services in Finland: a registry study of 36 715 patients

Intensive care–treated cardiac arrest: A retrospective study on the impact of extended age on mortality, neurological outcome, received treatments and healthcare-associated costs

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