Geriatric experience following cardiac arrest at Six Interventional Cardiology Centers in the United States 2006-2011: Interplay of age, do-not-resuscitate order, and outcomes

David B. Seder, Nainesh Patel, John McPherson, Paul McMullan, Karl B Kern, Barbara Unger, Sudip Nanda, Melkon Hacobian, Michael B. Kelley, Niklas Nielsen, John Dziodzio, Michael Mooney

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES:: It is not known if aggressive postresuscitation care, including therapeutic hypothermia and percutaneous coronary intervention, benefits cardiac arrest survivors more than 75 years old. We compared treatments and outcomes of patients at six regional percutaneous coronary intervention centers in the United States to determine if aggressive care of elderly patients was warranted. DESIGN:: Retrospective evaluation of registry data. SETTING:: Six interventional cardiology centers in the United States. PATIENTS:: Six hundred and twenty-five unresponsive cardiac arrest survivors aged 18-75 were compared with 129 similar patients aged more than 75. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Cardiac arrest survivors aged more than 75 had more comorbidities (3.0 ± 1.6 vs 2.0 ± 1.6, p < 0.001), but were matched to younger patients in initial heart rhythm, witnessed arrests, bystander cardiopulmonary resuscitation, and total ischemic time. Patients aged more than 75 frequently underwent therapeutic hypothermia (97.7%), urgent coronary angiography (44.2%), and urgent percutaneous coronary intervention (24%). They had more sustained hyperglycemia (70.5% vs 59%, p = 0.015), less postcooling fever (25.2% vs 35.2%, p = 0.03), were more likely to have do-not-resuscitate orders (65.9% vs 48.2%, p < 0.001), and undergo withdrawal of life support (61.2% vs 47.5%, p = 0.005). Good functional outcome at 6 months (Cerebral Performance Category 1-2) was seen in 27.9% elderly versus 40.4% younger patients overall (p = 0.01) and in 44% versus 55% (p = 0.13) of patients with an initial shockable rhythm. Of 35 survivors more than 75 years old, 33 (94.8%) were classified as Cerebral Performance Category 1 or 2 at (mean) 6.5-month follow-up. In multivariable logistic regression modeling, age more than 75 was significantly associated with outcome only when the presence of a do-not-resuscitate order was excluded from the model. CONCLUSIONS:: Elderly patients were more likely to have do-not-resuscitate orders and to undergo withdrawal of life support. Age was independently associated with outcome only when correction for do-not-resuscitate status was excluded, and functional outcomes of elderly survivors were similar to younger patients. Exclusion of patients more than 75 years old from aggressive care is not warranted on the basis of age alone.

Original languageEnglish (US)
Pages (from-to)289-295
Number of pages7
JournalCritical Care Medicine
Volume42
Issue number2
DOIs
StatePublished - Feb 2014

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Resuscitation Orders
Heart Arrest
Cardiology
Geriatrics
Survivors
Percutaneous Coronary Intervention
Induced Hypothermia
Cardiopulmonary Resuscitation
Coronary Angiography
Hyperglycemia
Registries
Comorbidity
Patient Care
Fever
Logistic Models

Keywords

  • Age
  • Cardiac Arrest
  • Code Status
  • Do Not Resuscitate
  • Geriatric
  • Hypothermia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Geriatric experience following cardiac arrest at Six Interventional Cardiology Centers in the United States 2006-2011 : Interplay of age, do-not-resuscitate order, and outcomes. / Seder, David B.; Patel, Nainesh; McPherson, John; McMullan, Paul; Kern, Karl B; Unger, Barbara; Nanda, Sudip; Hacobian, Melkon; Kelley, Michael B.; Nielsen, Niklas; Dziodzio, John; Mooney, Michael.

In: Critical Care Medicine, Vol. 42, No. 2, 02.2014, p. 289-295.

Research output: Contribution to journalArticle

Seder, DB, Patel, N, McPherson, J, McMullan, P, Kern, KB, Unger, B, Nanda, S, Hacobian, M, Kelley, MB, Nielsen, N, Dziodzio, J & Mooney, M 2014, 'Geriatric experience following cardiac arrest at Six Interventional Cardiology Centers in the United States 2006-2011: Interplay of age, do-not-resuscitate order, and outcomes', Critical Care Medicine, vol. 42, no. 2, pp. 289-295. https://doi.org/10.1097/CCM.0b013e3182a26ec6
Seder, David B. ; Patel, Nainesh ; McPherson, John ; McMullan, Paul ; Kern, Karl B ; Unger, Barbara ; Nanda, Sudip ; Hacobian, Melkon ; Kelley, Michael B. ; Nielsen, Niklas ; Dziodzio, John ; Mooney, Michael. / Geriatric experience following cardiac arrest at Six Interventional Cardiology Centers in the United States 2006-2011 : Interplay of age, do-not-resuscitate order, and outcomes. In: Critical Care Medicine. 2014 ; Vol. 42, No. 2. pp. 289-295.
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abstract = "OBJECTIVES:: It is not known if aggressive postresuscitation care, including therapeutic hypothermia and percutaneous coronary intervention, benefits cardiac arrest survivors more than 75 years old. We compared treatments and outcomes of patients at six regional percutaneous coronary intervention centers in the United States to determine if aggressive care of elderly patients was warranted. DESIGN:: Retrospective evaluation of registry data. SETTING:: Six interventional cardiology centers in the United States. PATIENTS:: Six hundred and twenty-five unresponsive cardiac arrest survivors aged 18-75 were compared with 129 similar patients aged more than 75. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Cardiac arrest survivors aged more than 75 had more comorbidities (3.0 ± 1.6 vs 2.0 ± 1.6, p < 0.001), but were matched to younger patients in initial heart rhythm, witnessed arrests, bystander cardiopulmonary resuscitation, and total ischemic time. Patients aged more than 75 frequently underwent therapeutic hypothermia (97.7{\%}), urgent coronary angiography (44.2{\%}), and urgent percutaneous coronary intervention (24{\%}). They had more sustained hyperglycemia (70.5{\%} vs 59{\%}, p = 0.015), less postcooling fever (25.2{\%} vs 35.2{\%}, p = 0.03), were more likely to have do-not-resuscitate orders (65.9{\%} vs 48.2{\%}, p < 0.001), and undergo withdrawal of life support (61.2{\%} vs 47.5{\%}, p = 0.005). Good functional outcome at 6 months (Cerebral Performance Category 1-2) was seen in 27.9{\%} elderly versus 40.4{\%} younger patients overall (p = 0.01) and in 44{\%} versus 55{\%} (p = 0.13) of patients with an initial shockable rhythm. Of 35 survivors more than 75 years old, 33 (94.8{\%}) were classified as Cerebral Performance Category 1 or 2 at (mean) 6.5-month follow-up. In multivariable logistic regression modeling, age more than 75 was significantly associated with outcome only when the presence of a do-not-resuscitate order was excluded from the model. CONCLUSIONS:: Elderly patients were more likely to have do-not-resuscitate orders and to undergo withdrawal of life support. Age was independently associated with outcome only when correction for do-not-resuscitate status was excluded, and functional outcomes of elderly survivors were similar to younger patients. Exclusion of patients more than 75 years old from aggressive care is not warranted on the basis of age alone.",
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T1 - Geriatric experience following cardiac arrest at Six Interventional Cardiology Centers in the United States 2006-2011

T2 - Interplay of age, do-not-resuscitate order, and outcomes

AU - Seder, David B.

AU - Patel, Nainesh

AU - McPherson, John

AU - McMullan, Paul

AU - Kern, Karl B

AU - Unger, Barbara

AU - Nanda, Sudip

AU - Hacobian, Melkon

AU - Kelley, Michael B.

AU - Nielsen, Niklas

AU - Dziodzio, John

AU - Mooney, Michael

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N2 - OBJECTIVES:: It is not known if aggressive postresuscitation care, including therapeutic hypothermia and percutaneous coronary intervention, benefits cardiac arrest survivors more than 75 years old. We compared treatments and outcomes of patients at six regional percutaneous coronary intervention centers in the United States to determine if aggressive care of elderly patients was warranted. DESIGN:: Retrospective evaluation of registry data. SETTING:: Six interventional cardiology centers in the United States. PATIENTS:: Six hundred and twenty-five unresponsive cardiac arrest survivors aged 18-75 were compared with 129 similar patients aged more than 75. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Cardiac arrest survivors aged more than 75 had more comorbidities (3.0 ± 1.6 vs 2.0 ± 1.6, p < 0.001), but were matched to younger patients in initial heart rhythm, witnessed arrests, bystander cardiopulmonary resuscitation, and total ischemic time. Patients aged more than 75 frequently underwent therapeutic hypothermia (97.7%), urgent coronary angiography (44.2%), and urgent percutaneous coronary intervention (24%). They had more sustained hyperglycemia (70.5% vs 59%, p = 0.015), less postcooling fever (25.2% vs 35.2%, p = 0.03), were more likely to have do-not-resuscitate orders (65.9% vs 48.2%, p < 0.001), and undergo withdrawal of life support (61.2% vs 47.5%, p = 0.005). Good functional outcome at 6 months (Cerebral Performance Category 1-2) was seen in 27.9% elderly versus 40.4% younger patients overall (p = 0.01) and in 44% versus 55% (p = 0.13) of patients with an initial shockable rhythm. Of 35 survivors more than 75 years old, 33 (94.8%) were classified as Cerebral Performance Category 1 or 2 at (mean) 6.5-month follow-up. In multivariable logistic regression modeling, age more than 75 was significantly associated with outcome only when the presence of a do-not-resuscitate order was excluded from the model. CONCLUSIONS:: Elderly patients were more likely to have do-not-resuscitate orders and to undergo withdrawal of life support. Age was independently associated with outcome only when correction for do-not-resuscitate status was excluded, and functional outcomes of elderly survivors were similar to younger patients. Exclusion of patients more than 75 years old from aggressive care is not warranted on the basis of age alone.

AB - OBJECTIVES:: It is not known if aggressive postresuscitation care, including therapeutic hypothermia and percutaneous coronary intervention, benefits cardiac arrest survivors more than 75 years old. We compared treatments and outcomes of patients at six regional percutaneous coronary intervention centers in the United States to determine if aggressive care of elderly patients was warranted. DESIGN:: Retrospective evaluation of registry data. SETTING:: Six interventional cardiology centers in the United States. PATIENTS:: Six hundred and twenty-five unresponsive cardiac arrest survivors aged 18-75 were compared with 129 similar patients aged more than 75. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Cardiac arrest survivors aged more than 75 had more comorbidities (3.0 ± 1.6 vs 2.0 ± 1.6, p < 0.001), but were matched to younger patients in initial heart rhythm, witnessed arrests, bystander cardiopulmonary resuscitation, and total ischemic time. Patients aged more than 75 frequently underwent therapeutic hypothermia (97.7%), urgent coronary angiography (44.2%), and urgent percutaneous coronary intervention (24%). They had more sustained hyperglycemia (70.5% vs 59%, p = 0.015), less postcooling fever (25.2% vs 35.2%, p = 0.03), were more likely to have do-not-resuscitate orders (65.9% vs 48.2%, p < 0.001), and undergo withdrawal of life support (61.2% vs 47.5%, p = 0.005). Good functional outcome at 6 months (Cerebral Performance Category 1-2) was seen in 27.9% elderly versus 40.4% younger patients overall (p = 0.01) and in 44% versus 55% (p = 0.13) of patients with an initial shockable rhythm. Of 35 survivors more than 75 years old, 33 (94.8%) were classified as Cerebral Performance Category 1 or 2 at (mean) 6.5-month follow-up. In multivariable logistic regression modeling, age more than 75 was significantly associated with outcome only when the presence of a do-not-resuscitate order was excluded from the model. CONCLUSIONS:: Elderly patients were more likely to have do-not-resuscitate orders and to undergo withdrawal of life support. Age was independently associated with outcome only when correction for do-not-resuscitate status was excluded, and functional outcomes of elderly survivors were similar to younger patients. Exclusion of patients more than 75 years old from aggressive care is not warranted on the basis of age alone.

KW - Age

KW - Cardiac Arrest

KW - Code Status

KW - Do Not Resuscitate

KW - Geriatric

KW - Hypothermia

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