Age-specific prognostication after out-of-hospital cardiac arrest – The ethical dilemma between ‘life-sustaining treatment’ and ‘the right to die’ in the elderly
Background: While prognostic values on survival after out-of-hospital cardiac arrest have been well investigated, less attention has been paid to their age-specific relevance. Therefore, we aimed to identify suitable age-specific early prognostication in elderly patients suffering out-of-hospital ca...
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| Veröffentlicht in: | European heart journal. Acute cardiovascular care 2017-03, Vol.6 (2), p.112-120 |
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| creator | Sulzgruber, Patrick Sterz, Fritz Poppe, Michael Schober, Andreas Lobmeyr, Elisabeth Datler, Philip Keferböck, Markus Zeiner, Sebastian Nürnberger, Alexander Hubner, Pia Stratil, Peter Wallmueller, Christian Weiser, Christoph Warenits, Alexandra-Maria van Tulder, Raphael Zajicek, Andreas Buchinger, Angelika Testori, Christoph |
| description | Background:
While prognostic values on survival after out-of-hospital cardiac arrest have been well investigated, less attention has been paid to their age-specific relevance. Therefore, we aimed to identify suitable age-specific early prognostication in elderly patients suffering out-of-hospital cardiac arrest in order to reduce the burden of unnecessary treatment and harm.
Methods:
In a prospective population-based observational trial on individuals suffering out-of-hospital cardiac arrest, a total of 2223 patients receiving resuscitation attempts by the local emergency medical service in Vienna, Austria, were enrolled. Patients were stratified according to age as follows: young and middle-aged individuals (85 years).
Results:
There was an increasing rate of 30-day mortality (+21.8%, p |
| doi_str_mv | 10.1177/2048872616672076 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1859722430</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_2048872616672076</sage_id><sourcerecordid>1859722430</sourcerecordid><originalsourceid>FETCH-LOGICAL-c379t-73cd04cf00face9e508e51a0c07ed5fe5b2474fe2136412f463d1ad3c2c01d593</originalsourceid><addsrcrecordid>eNp1kb1uFTEQhS0EIlFIT4Vc0iz4b-3dMor4kyLRhHrla4_3OvLaF9srlC7vQBOegbfKk-DVDSmQcGNr5jvHmjkIvabkHaVKvWdEDINikkqpGFHyGTrdSt2guHj-9GbyBJ2XckPaUUSKgb9EJ0xJOSo2nqLfFzN05QDGO2_wIac5plK90dWniLWrkHFaa5dct0_l4KsO2OhsvTZY5wyl4oe7n_h6DxjqvukCtj7Asmi8g_oDILb-ffCu_bKWqn30ccY1g64LxPpw9wvraDemNovs533FNTUP2Fo-4q0MwUIOt6_QC6dDgfPH-wx9-_jh-vJzd_X105fLi6vOcDXWTnFjiTCOEKcNjNCTAXqqiSEKbO-g3zGhhANGuRSUOSG5pdpywwyhth_5GXp79G3r-L62EafFFwMh6AhpLRMd-rY8JjhpKDmiJqdSMrjpkP2i8-1EybSlNP2bUpO8eXRfdwvYJ8HfTBrQHYGiZ5hu0ppjm_b_hn8ANTyhag</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1859722430</pqid></control><display><type>article</type><title>Age-specific prognostication after out-of-hospital cardiac arrest – The ethical dilemma between ‘life-sustaining treatment’ and ‘the right to die’ in the elderly</title><source>Access via SAGE</source><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Sulzgruber, Patrick ; Sterz, Fritz ; Poppe, Michael ; Schober, Andreas ; Lobmeyr, Elisabeth ; Datler, Philip ; Keferböck, Markus ; Zeiner, Sebastian ; Nürnberger, Alexander ; Hubner, Pia ; Stratil, Peter ; Wallmueller, Christian ; Weiser, Christoph ; Warenits, Alexandra-Maria ; van Tulder, Raphael ; Zajicek, Andreas ; Buchinger, Angelika ; Testori, Christoph</creator><creatorcontrib>Sulzgruber, Patrick ; Sterz, Fritz ; Poppe, Michael ; Schober, Andreas ; Lobmeyr, Elisabeth ; Datler, Philip ; Keferböck, Markus ; Zeiner, Sebastian ; Nürnberger, Alexander ; Hubner, Pia ; Stratil, Peter ; Wallmueller, Christian ; Weiser, Christoph ; Warenits, Alexandra-Maria ; van Tulder, Raphael ; Zajicek, Andreas ; Buchinger, Angelika ; Testori, Christoph</creatorcontrib><description>Background:
While prognostic values on survival after out-of-hospital cardiac arrest have been well investigated, less attention has been paid to their age-specific relevance. Therefore, we aimed to identify suitable age-specific early prognostication in elderly patients suffering out-of-hospital cardiac arrest in order to reduce the burden of unnecessary treatment and harm.
Methods:
In a prospective population-based observational trial on individuals suffering out-of-hospital cardiac arrest, a total of 2223 patients receiving resuscitation attempts by the local emergency medical service in Vienna, Austria, were enrolled. Patients were stratified according to age as follows: young and middle-aged individuals (<65 years), young old individuals (65–74 years), old individuals (75–84 years) and very old individuals (>85 years).
Results:
There was an increasing rate of 30-day mortality (+21.8%, p < 0.001) and unfavourable neurological outcome (+18.8%, p < 0.001) with increasing age among age groups. Established predictive variables lost their prognostic potential with increasing age, even after adjusting for potential confounders. Independently, an initially shockable electrocardiogram proved to be directly associated with survival, with an adjusted hazard ratio (HR) of 2.04 (95% confidence interval (CI) 1.89–2.38, p = 0.003) for >85-year-olds. Frailty was directly associated with mortality (HR 1.22, 95% CI 1.01–1.51, p = 0.049), showing a 30-day survival of 5.6% and a favourable neurological outcome of 1.1% among elderly individuals.
Conclusion:
An initially shockable electrocardiogram proved to be a suitable tool for risk assessment and decision making in order to predict a successful outcome in elderly victims of out-of-hospital cardiac arrest. However, the outcomes of elderly patients seemed to be exceptionally poor in frail individuals and need to be considered in order to reduce unnecessary treatment decisions.</description><identifier>ISSN: 2048-8726</identifier><identifier>EISSN: 2048-8734</identifier><identifier>DOI: 10.1177/2048872616672076</identifier><identifier>PMID: 27669729</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Age Factors ; Aged ; Aged, 80 and over ; Austria ; Cardiopulmonary Resuscitation - mortality ; Emergency Medical Services - methods ; Female ; Humans ; Male ; Out-of-Hospital Cardiac Arrest - complications ; Out-of-Hospital Cardiac Arrest - therapy ; Prognosis ; Prospective Studies ; Retrospective Studies ; Right to Die - ethics ; Treatment Outcome</subject><ispartof>European heart journal. Acute cardiovascular care, 2017-03, Vol.6 (2), p.112-120</ispartof><rights>The European Society of Cardiology 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c379t-73cd04cf00face9e508e51a0c07ed5fe5b2474fe2136412f463d1ad3c2c01d593</citedby><cites>FETCH-LOGICAL-c379t-73cd04cf00face9e508e51a0c07ed5fe5b2474fe2136412f463d1ad3c2c01d593</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2048872616672076$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2048872616672076$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27669729$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sulzgruber, Patrick</creatorcontrib><creatorcontrib>Sterz, Fritz</creatorcontrib><creatorcontrib>Poppe, Michael</creatorcontrib><creatorcontrib>Schober, Andreas</creatorcontrib><creatorcontrib>Lobmeyr, Elisabeth</creatorcontrib><creatorcontrib>Datler, Philip</creatorcontrib><creatorcontrib>Keferböck, Markus</creatorcontrib><creatorcontrib>Zeiner, Sebastian</creatorcontrib><creatorcontrib>Nürnberger, Alexander</creatorcontrib><creatorcontrib>Hubner, Pia</creatorcontrib><creatorcontrib>Stratil, Peter</creatorcontrib><creatorcontrib>Wallmueller, Christian</creatorcontrib><creatorcontrib>Weiser, Christoph</creatorcontrib><creatorcontrib>Warenits, Alexandra-Maria</creatorcontrib><creatorcontrib>van Tulder, Raphael</creatorcontrib><creatorcontrib>Zajicek, Andreas</creatorcontrib><creatorcontrib>Buchinger, Angelika</creatorcontrib><creatorcontrib>Testori, Christoph</creatorcontrib><title>Age-specific prognostication after out-of-hospital cardiac arrest – The ethical dilemma between ‘life-sustaining treatment’ and ‘the right to die’ in the elderly</title><title>European heart journal. Acute cardiovascular care</title><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><description>Background:
While prognostic values on survival after out-of-hospital cardiac arrest have been well investigated, less attention has been paid to their age-specific relevance. Therefore, we aimed to identify suitable age-specific early prognostication in elderly patients suffering out-of-hospital cardiac arrest in order to reduce the burden of unnecessary treatment and harm.
Methods:
In a prospective population-based observational trial on individuals suffering out-of-hospital cardiac arrest, a total of 2223 patients receiving resuscitation attempts by the local emergency medical service in Vienna, Austria, were enrolled. Patients were stratified according to age as follows: young and middle-aged individuals (<65 years), young old individuals (65–74 years), old individuals (75–84 years) and very old individuals (>85 years).
Results:
There was an increasing rate of 30-day mortality (+21.8%, p < 0.001) and unfavourable neurological outcome (+18.8%, p < 0.001) with increasing age among age groups. Established predictive variables lost their prognostic potential with increasing age, even after adjusting for potential confounders. Independently, an initially shockable electrocardiogram proved to be directly associated with survival, with an adjusted hazard ratio (HR) of 2.04 (95% confidence interval (CI) 1.89–2.38, p = 0.003) for >85-year-olds. Frailty was directly associated with mortality (HR 1.22, 95% CI 1.01–1.51, p = 0.049), showing a 30-day survival of 5.6% and a favourable neurological outcome of 1.1% among elderly individuals.
Conclusion:
An initially shockable electrocardiogram proved to be a suitable tool for risk assessment and decision making in order to predict a successful outcome in elderly victims of out-of-hospital cardiac arrest. However, the outcomes of elderly patients seemed to be exceptionally poor in frail individuals and need to be considered in order to reduce unnecessary treatment decisions.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Austria</subject><subject>Cardiopulmonary Resuscitation - mortality</subject><subject>Emergency Medical Services - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Out-of-Hospital Cardiac Arrest - complications</subject><subject>Out-of-Hospital Cardiac Arrest - therapy</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Right to Die - ethics</subject><subject>Treatment Outcome</subject><issn>2048-8726</issn><issn>2048-8734</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kb1uFTEQhS0EIlFIT4Vc0iz4b-3dMor4kyLRhHrla4_3OvLaF9srlC7vQBOegbfKk-DVDSmQcGNr5jvHmjkIvabkHaVKvWdEDINikkqpGFHyGTrdSt2guHj-9GbyBJ2XckPaUUSKgb9EJ0xJOSo2nqLfFzN05QDGO2_wIac5plK90dWniLWrkHFaa5dct0_l4KsO2OhsvTZY5wyl4oe7n_h6DxjqvukCtj7Asmi8g_oDILb-ffCu_bKWqn30ccY1g64LxPpw9wvraDemNovs533FNTUP2Fo-4q0MwUIOt6_QC6dDgfPH-wx9-_jh-vJzd_X105fLi6vOcDXWTnFjiTCOEKcNjNCTAXqqiSEKbO-g3zGhhANGuRSUOSG5pdpywwyhth_5GXp79G3r-L62EafFFwMh6AhpLRMd-rY8JjhpKDmiJqdSMrjpkP2i8-1EybSlNP2bUpO8eXRfdwvYJ8HfTBrQHYGiZ5hu0ppjm_b_hn8ANTyhag</recordid><startdate>201703</startdate><enddate>201703</enddate><creator>Sulzgruber, Patrick</creator><creator>Sterz, Fritz</creator><creator>Poppe, Michael</creator><creator>Schober, Andreas</creator><creator>Lobmeyr, Elisabeth</creator><creator>Datler, Philip</creator><creator>Keferböck, Markus</creator><creator>Zeiner, Sebastian</creator><creator>Nürnberger, Alexander</creator><creator>Hubner, Pia</creator><creator>Stratil, Peter</creator><creator>Wallmueller, Christian</creator><creator>Weiser, Christoph</creator><creator>Warenits, Alexandra-Maria</creator><creator>van Tulder, Raphael</creator><creator>Zajicek, Andreas</creator><creator>Buchinger, Angelika</creator><creator>Testori, Christoph</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201703</creationdate><title>Age-specific prognostication after out-of-hospital cardiac arrest – The ethical dilemma between ‘life-sustaining treatment’ and ‘the right to die’ in the elderly</title><author>Sulzgruber, Patrick ; Sterz, Fritz ; Poppe, Michael ; Schober, Andreas ; Lobmeyr, Elisabeth ; Datler, Philip ; Keferböck, Markus ; Zeiner, Sebastian ; Nürnberger, Alexander ; Hubner, Pia ; Stratil, Peter ; Wallmueller, Christian ; Weiser, Christoph ; Warenits, Alexandra-Maria ; van Tulder, Raphael ; Zajicek, Andreas ; Buchinger, Angelika ; Testori, Christoph</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c379t-73cd04cf00face9e508e51a0c07ed5fe5b2474fe2136412f463d1ad3c2c01d593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Austria</topic><topic>Cardiopulmonary Resuscitation - mortality</topic><topic>Emergency Medical Services - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Out-of-Hospital Cardiac Arrest - complications</topic><topic>Out-of-Hospital Cardiac Arrest - therapy</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Right to Die - ethics</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sulzgruber, Patrick</creatorcontrib><creatorcontrib>Sterz, Fritz</creatorcontrib><creatorcontrib>Poppe, Michael</creatorcontrib><creatorcontrib>Schober, Andreas</creatorcontrib><creatorcontrib>Lobmeyr, Elisabeth</creatorcontrib><creatorcontrib>Datler, Philip</creatorcontrib><creatorcontrib>Keferböck, Markus</creatorcontrib><creatorcontrib>Zeiner, Sebastian</creatorcontrib><creatorcontrib>Nürnberger, Alexander</creatorcontrib><creatorcontrib>Hubner, Pia</creatorcontrib><creatorcontrib>Stratil, Peter</creatorcontrib><creatorcontrib>Wallmueller, Christian</creatorcontrib><creatorcontrib>Weiser, Christoph</creatorcontrib><creatorcontrib>Warenits, Alexandra-Maria</creatorcontrib><creatorcontrib>van Tulder, Raphael</creatorcontrib><creatorcontrib>Zajicek, Andreas</creatorcontrib><creatorcontrib>Buchinger, Angelika</creatorcontrib><creatorcontrib>Testori, Christoph</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal. Acute cardiovascular care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sulzgruber, Patrick</au><au>Sterz, Fritz</au><au>Poppe, Michael</au><au>Schober, Andreas</au><au>Lobmeyr, Elisabeth</au><au>Datler, Philip</au><au>Keferböck, Markus</au><au>Zeiner, Sebastian</au><au>Nürnberger, Alexander</au><au>Hubner, Pia</au><au>Stratil, Peter</au><au>Wallmueller, Christian</au><au>Weiser, Christoph</au><au>Warenits, Alexandra-Maria</au><au>van Tulder, Raphael</au><au>Zajicek, Andreas</au><au>Buchinger, Angelika</au><au>Testori, Christoph</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Age-specific prognostication after out-of-hospital cardiac arrest – The ethical dilemma between ‘life-sustaining treatment’ and ‘the right to die’ in the elderly</atitle><jtitle>European heart journal. Acute cardiovascular care</jtitle><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><date>2017-03</date><risdate>2017</risdate><volume>6</volume><issue>2</issue><spage>112</spage><epage>120</epage><pages>112-120</pages><issn>2048-8726</issn><eissn>2048-8734</eissn><abstract>Background:
While prognostic values on survival after out-of-hospital cardiac arrest have been well investigated, less attention has been paid to their age-specific relevance. Therefore, we aimed to identify suitable age-specific early prognostication in elderly patients suffering out-of-hospital cardiac arrest in order to reduce the burden of unnecessary treatment and harm.
Methods:
In a prospective population-based observational trial on individuals suffering out-of-hospital cardiac arrest, a total of 2223 patients receiving resuscitation attempts by the local emergency medical service in Vienna, Austria, were enrolled. Patients were stratified according to age as follows: young and middle-aged individuals (<65 years), young old individuals (65–74 years), old individuals (75–84 years) and very old individuals (>85 years).
Results:
There was an increasing rate of 30-day mortality (+21.8%, p < 0.001) and unfavourable neurological outcome (+18.8%, p < 0.001) with increasing age among age groups. Established predictive variables lost their prognostic potential with increasing age, even after adjusting for potential confounders. Independently, an initially shockable electrocardiogram proved to be directly associated with survival, with an adjusted hazard ratio (HR) of 2.04 (95% confidence interval (CI) 1.89–2.38, p = 0.003) for >85-year-olds. Frailty was directly associated with mortality (HR 1.22, 95% CI 1.01–1.51, p = 0.049), showing a 30-day survival of 5.6% and a favourable neurological outcome of 1.1% among elderly individuals.
Conclusion:
An initially shockable electrocardiogram proved to be a suitable tool for risk assessment and decision making in order to predict a successful outcome in elderly victims of out-of-hospital cardiac arrest. However, the outcomes of elderly patients seemed to be exceptionally poor in frail individuals and need to be considered in order to reduce unnecessary treatment decisions.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>27669729</pmid><doi>10.1177/2048872616672076</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Age Factors Aged Aged, 80 and over Austria Cardiopulmonary Resuscitation - mortality Emergency Medical Services - methods Female Humans Male Out-of-Hospital Cardiac Arrest - complications Out-of-Hospital Cardiac Arrest - therapy Prognosis Prospective Studies Retrospective Studies Right to Die - ethics Treatment Outcome |
| title | Age-specific prognostication after out-of-hospital cardiac arrest – The ethical dilemma between ‘life-sustaining treatment’ and ‘the right to die’ in the elderly |
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