Influences on the duration and success of out-of-hospital resuscitation of geriatric patients over 80 years of age - a retrospective evaluation.

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Nils Heuser, Dennis Rupp, Susanne Glass, Martin Christian Sassen, Astrid Morin, Christian Volberg
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引用次数: 0

Abstract

Background: Society is experiencing an increasing shift in the age distribution and accordingly, increased resuscitation rates of patients over 80 years and older. In 2022, more than 34% of people resuscitated in Germany were older than 80 years, although older age is considered a poor predictor for the outcome of cardiopulmonary resuscitation (CPR). Professional societies provide ethical recommendations on when resuscitation may be considered futile and should be terminated. However, the extent to which these recommendations are implemented is unclear.

Methods: Retrospective evaluation of pre-hospital documentation of out-of-hospital resuscitations in patients ≥ 80 years of age in the period 01/01/2014-12/31/2022 in one German county combined with data of the German Resuscitation Registry. For statistical testing, the significance level was set at p < 0.05.

Results: In total 578 cases were analyzed. Return of spontaneous circulation (ROSC): 26% (n = 148). Survival to discharge: 6.1% (n = 35). Median CPR duration: 17 min (10-28 min). The older the patients were, the worse the survival rate (p = 0.05) and the shorter the time to termination (p < 0.0001). No patient over 90 years of age was discharged alive. Resuscitation was also significantly shorter until termination with poorer ASA (American Society of Anesthesiologists) score (p < 0.001). Residents resuscitated significantly longer than specialists (p = 0.02). In surviving patients, there was a significant correlation between short CPR duration and good cerebral performance category (CPC) value: Median CPC1/2 = 5 min [3-10 min] vs. CPC 3/4 = 18 min [10-21 min]; p = 0.01.

Interpretation: Old age and poor health status is associated with shorter CPR duration until termination and older age is associated with poorer prognosis in out-of-hospital cardiac arrest (OHCA) concerning the possibility of return of spontaneous circulation (ROSC) and survival. A short resuscitation time is associated with a better CPC value. Therefore, when resuscitating patients over 80 years of age, even greater care should be taken to ensure that reversible causes are quickly corrected in order to achieve a ROSC and a good neurological outcome. Alternatively, resuscitation should be terminated promptly, as good survival can no longer be guaranteed. Resuscitation lasting more than 20 min should be avoided in any case, in line with the termination of resuscitation (ToR) criteria.

对 80 岁以上老年患者进行院外复苏的持续时间和成功率的影响 - 一项回顾性评估。
背景:社会的年龄分布正在发生变化,80 岁及以上患者的复苏率也相应增加。2022 年,德国超过 34% 的复苏者年龄超过 80 岁,尽管年龄较大被认为是心肺复苏(CPR)结果的不良预测因素。专业协会提供了伦理建议,说明何时可认为复苏无效并应终止。然而,这些建议的实施程度尚不清楚:方法:结合德国复苏登记处的数据,对德国某县 2014 年 1 月 1 日至 2022 年 12 月 31 日期间年龄≥ 80 岁患者的院外复苏院前记录进行回顾性评估。统计检验的显著性水平设定为 p 结果:共分析了 578 个病例。自发性循环恢复(ROSC):26%(n = 148)。出院后存活率6.1% (n = 35).心肺复苏持续时间中位数:17 分钟(10-28 分钟):17分钟(10-28分钟)。患者年龄越大,存活率越低(p = 0.05),终止时间越短(p 解释: 患者年龄越大,健康状况越差,存活率越低(p = 0.05),终止时间越短(p = 0.05):在院外心脏骤停(OHCA)患者中,高龄和健康状况差与心肺复苏持续时间较短有关,而高龄与自发性循环恢复(ROSC)和存活率的预后较差有关。复苏时间越短,CPC 值越高。因此,在对 80 岁以上的患者进行复苏时,应更加注意确保迅速纠正可逆的原因,以实现 ROSC 和良好的神经功能预后。或者,由于无法保证良好的存活率,应立即终止复苏。根据复苏终止(ToR)标准,在任何情况下都应避免复苏时间超过 20 分钟。
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来源期刊
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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