Mortality and neurological outcome in the elderly after target temperature management for out-of-hospital cardiac arrest |
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| Affiliation: | 1. The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark;2. Department of Intensive Care, Santa Maria degli Angeli, Pordenone, Italy;3. Department of Intensive Care, Leeuwarden Medical Centrum, Leeuwarden, The Netherlands;4. Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden;5. Copenhagen Trial Unit, Centre of Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark;6. Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden;7. Department of Cardiology, Skåne University Hospital, Lund, Sweden;8. Department of Anesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden;9. Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland;10. Department of Intensive Care, Academic Medical Centrum, Amsterdam, The Netherlands;11. Department of Anesthesia and Intensive Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway;12. Department of Anesthesia and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg;13. Department of Intensive Care, University Hospital of Wales, Cardiff, United Kingdom;14. Department of Intensive Care, Liverpool hospital, Sydney, New South Wales, Australia;1. University of Arizona Sarver Heart Center, Tucson, Arizona;2. Zoll Circulation, San Jose, California;3. University of Basel, Basel, Switzerland;1. University of Pittsburgh, Pittsburgh, PA, United States;2. University of Washington, Seattle, WA, United States;3. Legacy Health System, Portland, OR, United States;4. University of British Columbia, Vancouver, BC, United States;5. Medical College of Wisconsin, Milwaukee, WI, United States;6. Oregon Health and Science University, Portland, OR, United States;7. University of Toronto, Toronto, ON, United States;8. University of California, San Diego, La Jolla, CA, United States;9. University of Texas, Southwestern, Dallas, TX, United States;10. Virginia Commonwealth University, Richmond, VA, United States;11. University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, United States;1. Division of Cardiology, Harbor UCLA Medical Center, Torrance, California;2. Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California;3. Albany Medical College, Albany, New York;4. Department of Neurology, University of Southern California, Los Angeles, California;5. Division of Cardiology, University of Southern California, Los Angeles, California;6. Los Angeles County Emergency Medical Services Agency, Los Angeles, California;1. University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, CO, United States;2. University of Pennsylvania, Perelman School of Medicine, Department of Biostatistics and Epidemiology, Philadelphia, PA, United States;3. University of Pennsylvania, Perelman School of Medicine, Department of Emergency Medicine, Philadelphia, PA, United States;4. University of Pennsylvania, Department of Emergency Medicine, Center for Resuscitation Science, Philadelphia, PA, United States;1. Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Denmark;2. Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway;3. Research Centre for Emergency Medicine and Department of Intensive Care Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark;4. Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway;5. Department of Clinical Medicine, University of Bergen, Bergen, Norway |
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| Abstract: | AimTo assess older age as a prognostic factor in patients resuscitated from out-of-hospital-cardiac arrest (OHCA) and the interaction between age and level of target temperature management.Methods and results950 patients included in the target temperature management (TTM) trial were randomly allocated to TTM at 33 or 36 °C for 24 h. We assessed survival and cerebral outcome (cerebral performance category, CPC and modified Rankin scale, mRS) using age as predictor, dividing patients into 5 age groups: ≤65 (median), 66–70, 71–75, 76–80 and >80 years of age. Shockable rhythm decreased with higher age groups, p = 0.001, the same was true for ST segment elevation on ECG at admission, p < 0.01. Increasing age was associated with a higher mortality rate (HR = 1.04 per year, 95% CI = 1.03–1.06, p < 0.001) after adjusting for confounders. Octogenarians had an increased mortality (HR = 3.5, CI: 2.5–5.0, p < 0.001) compared to patients ≤65 years of age. Favorable vs. unfavorable outcome measured by CPC and mRS in survivors was different between age groups with adverse outcomes more prevalent in higher age groups (CPC: p = 0.04, mRS: p = 0.001). The interaction between age and target temperature allocation was not statistically significant for either mortality or neurological outcome.ConclusionIncreasing age is associated with significantly increased mortality after OHCA, but mortality rate is not influenced by level of target temperature. Risk of poor neurological outcome also increases with age, but is not modified by level of target temperature. |
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| Keywords: | Out-of hospital cardiac arrest Therapeutic hypothermia Age |
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