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Out-of-hospital cardiac arrests in the older population in Ireland
  1. Richard Tanner1,2,
  2. Siobhan Masterson3,4,
  3. Mette Jensen3,
  4. Peter Wright5,
  5. David Hennelly6,
  6. Martin O’Reilly7,
  7. Andrew W Murphy3,
  8. Gerard Bury8,
  9. Cathal O’Donnell6,
  10. Conor Deasy1,2,6
  11. On behalf of the Out of Hospital Cardiac Arrest Register Steering Committee
  1. 1 Department of Emergency Medicine, Cork University Hospital, Wilton, Cork, Ireland
  2. 2 University College Cork, Cork, Ireland
  3. 3 Discipline of General Practice, National University of Ireland, Galway, Ireland
  4. 4 Department of Public Health Medicine, Health Service Executive, Letterkenny, Donegal, Ireland
  5. 5 Department of Public Health Medicine, HealthService Executive, Limerick, Ireland
  6. 6 National Ambulance Service, Health Service Executive, Naas, Ireland
  7. 7 Dublin Fire Brigade, Dublin, Ireland
  8. 8 Centre for Emergency Medical Science, University College Dublin, Dublin, Ireland
  1. Correspondence to Dr Richard Tanner, Department of Emergency Medicine, Cork University Hospital, Wilton, Cork, Ireland; 107577656{at}umail.ucc.ie

Abstract

Introduction Age influences survival from an out-of-hospital cardiac arrest (OHCA) but it is unclear to what extent. Improved understanding of the impact of increasing age may be helpful in improving decision making on who should receive attempted resuscitation to optimise outcomes and minimise inappropriate end-of-life management. Our aim is to describe the demographics, characteristics and outcomes following resuscitation attempts in OHCA patients aged 70 years and older in Ireland.

Methods Data were extracted from the national OHCA Register. Patient and event characteristics were compared across three age categories (70-79; 80-89; ≥90 years). Multivariable logistic regression was used to determine the predictors of the primary outcome (survival to hospital discharge).

Results A total of 2281 patients aged 70 years and older were attended by emergency medical services and had resuscitation attempted between 2012 and 2014. Overall survival to hospital discharge was 2.9%. For those aged 70–79 years, 80–89 years, 90 years and older survival to hospital discharge in each age group was 4.0%, 1.8% and 1.4%, respectively. Older age (adjusted OR (AOR) 0.95 95% CI 0.90 to 0.99) and having an arrest in the subjects own home (AOR 0.14 95% CI 0.07 to 0.28) were independent predictor associated with reduced odds of survival to hospital discharge. An initial shockable rhythm (AOR 17.9. 95% CI 8.19 to 39.2) and having a bystander witnessed OHCA (AOR 3.98. 95% CI 1.38 to 11.50) were independent predictors associated with increased odds of survival to hospital discharge.

Conclusion In those aged 70 years and older, the rate of survival to hospital discharge declined with increasing age group. Younger age, an initial shockable rhythm and witnessed arrest were independent predictors of survival to hospital discharge.

  • older population

http://dx.doi.org/10.1136/emermed-2016-206041

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    Footnotes

    • Contributors RT: lead author; collected data, completed literature review, constructed data tables, completed statistical analysis and coordinated input from coauthors. MJ: contributed to initial planning/methodology and literature review of project; heavily involved in editing of final project draft. SM: contributed to planning/methodology of project; provided guidance on statistical analysis; heavily involved again in writing the final draft. PW:involved in planning and gave key input from a public health point of view; involved in editing and correction of project. DH: national ambulance service (NAS); provided up-to-date information on initiatives by the NAS for OHCAs; ensured information regarding the NAS was accurate; provided editing on final draft of project. MO’R:represented the Emergency Medical Services in Dublin and provided practical guidance from his experience as part of the National Ambulance Service; involved in editing each draft before submission to EMJ. AWM: input from a general practitioner’s point of view; highlighted information that would be useful in day-to-day practice; provided editing before final draft submitted. GB: input on drafting presentation of results and writing final draft of this paper. CO’D:represented the NAS and provided information the structure of the NAS and interventions being used to improve outcomes from OHCA; also involved in editing of project. CD: project supervisor; involved in all steps of project;form initial planning to presentation of data to final edits.

    • Funding This is a voluntary project. There was no external funding.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval Cork research ethics committee (CREC).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All relevant data have been included.

    • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.