The outcome of in- and out-hospital cardiopulmonary arrest in the older population: a scoping review

Abstract

Purpose: We aimed to collect the available evidence on outcome regarding survival and quality of life after cardiopulmonary resuscitation (CPR) following both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) in the older population.

Methods: A scoping review was performed studying published reviews after 2008, focusing on outcome of CPR in patients aged ≥ 70 years following IHCA and OHCA. In addition, 11 (IHCA) and 19 (OHCA) eligible studies published after the 2 included reviews were analyzed regarding: return of spontaneous circulation, survival until hospital discharge, long-term survival, neurological outcome, discharge location or other measurements for quality of life (QoL).

Results: The survival until hospital discharge ranged between 11.6 and 28.5% for IHCA and 0-11.1% for OHCA, and declined with increasing age. The same trend was seen regarding 1-year survival rates with 5.7-25.0% and 0-10% following IHCA and OHCA, respectively. A good neurological outcome defined as a Cerebral Performance Category (CPC) 1-2 was found in 11.5-23.6% (IHCA) and up to 10.5% (OHCA) of all patients. However, the proportion of CPC 1-2 among patients surviving until hospital discharge was 82-93% (IHCA) and 77-91.6% (OHCA). Few studies included other QoL measures as an outcome variable. Other risk factors aside from age were identified, including nursing home residency, comorbidity, non-shockable rhythm, non-witnessed arrest. The level of frailty was not studied as a predictor of arrest outcome in the included studies.

Conclusions: Hospital survival rates following IHCA and OHCA in the older population improved in the recent decade, though do not exceed 28.5% and 11.1%, respectively. The effect of age on outcome remains controversial and age should not be used as the sole decision criterium whether to initiate CPR. Future research should study frailty and resilience as an independent predictor regardless of age, and add broader, extensive QoL measures as outcome variables.

Keywords: Age; CPR; Functional state; Neurological outcome; Quality of life; Survival.