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. 2024 Feb 9:17:100573.
doi: 10.1016/j.resplu.2024.100573. eCollection 2024 Mar.

Increasing neurologically intact survival after out-of-hospital cardiac arrest among elderly: Singapore Experience

Chloe Alexis Ong  1 , Gayathri Devi Nadarajan  2 , Stephanie Fook-Chong  3 , Nur Shahidah  2   3 , Shalini Arulanandam  4 , Yih Yng Ng  1   5   6 , Michael Yc Chia  7 , Ling Tiah  8 , Desmond R Mao  9 , Wei Ming Ng  10 , Benjamin Sh Leong  11 , Nausheen Doctor  12 , Marcus Eh Ong  2   13 , Fahad J Siddiqui  3
Affiliations

Increasing neurologically intact survival after out-of-hospital cardiac arrest among elderly: Singapore Experience

Chloe Alexis Ong et al. Resusc Plus. .

Abstract

Objectives: With more elderly presenting with Out-of-Hospital Cardiac Arrests (OHCAs) globally, neurologically intact survival (NIS) should be the aim of resuscitation. We aimed to study the trend of OHCA amongst elderly in a large Asian registry to identify if age is independently associated with NIS and factors associated with NIS.

Methods: All adult OHCAs aged ≥18 years attended by emergency medical services (EMS) from April 2010 to December 2019 in Singapore was extracted from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. Cases pronounced dead at scene, non-EMS transported, traumatic OHCAs and OHCAs in ambulances were excluded. Patient characteristics and outcomes were compared across four age categories (18-64, 65-79, 80-89, ≥90). Multivariable logistic regression analysis determined the factors associated with NIS.

Results: 19,519 eligible cases were analyzed. OHCA incidence increased with age almost doubling in octogenarians (from 312/100,000 in 2011 to 652/100,000 in 2019) and tripling in those ≥90 years (from 458/100,000 in 2011 to 1271/100,000 in 2019). The proportion of patients with NIS improved over time for the 18-64, 65-79- and 80-89-years age groups, with the greatest improvement in the youngest group. NIS decreased with each increasing year of age and minute of response time. NIS increased in the arrests of presumed cardiac etiology, witnessed and bystander CPR.

Conclusions: Survival with good outcomes has increased even amongst the elderly. Regardless of age, NIS is possible with good-quality CPR, highlighting its importance. End-of-life planning is a complex yet necessary decision that requires qualitative exploration with elderly, their families and care providers.

Keywords: Cardiopulmonary resuscitation; Elderly; Epidemiology; Out-of-hospital cardiac arrest; Quality of life.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MEH Ong reports grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices. MEH Ong has a licensing agreement with ZOLL Medical Corporation and patent filed (Application no: 13/047,348) for a “Method of predicting acute cardiopulmonary events and survivability of a patient.” He is also the co-founder and scientific advisor of TIIM Healthcare, a commercial entity which develops real-time prediction and risk stratification solutions for triage. All other authors have no conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Patient flowchart.
Fig. 2
Fig. 2
Number and incidence rate of OHCA (per 100,000 residents) for various age groups over time.
Fig. 3
Fig. 3
Time tend of percentage of neurologically favorable survival to hospital discharge, stratified by age groups.
Fig. 4
Fig. 4
Plot of neurologically intact survival with 95% CI according to age, stratified by subgroup of best-case scenario.
See this image and copyright information in PMC

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