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After surviving in-hospital CPR to discharge, 60% of elderly alive at 1 year, 44% at 3 years

Clinical Question:
What is the prognosis for patients 65 years and older who survive an episode of in-hospital cardiac arrest?

Bottom Line:
Long-term survival following successful in-hospital cardiopulmonary resuscitation (CPR) is better than some might expect, and is strongly influenced by age and neurologic status at discharge. (LOE = 1b)

Reference:
Chan PS, Nallamothu BK, Krumholz HM, et al, for the American Heart Association Get with the Guidelines -- Resuscitation Investigators. Long-term outcomes in elderly survivors of in-hospital cardiac arrest. N Engl J Med 2013;368(11):1019-1026.  [PMID:23484828]

Study Design:
Cohort (prospective)

Funding:
Foundation

Setting:
Inpatient (any location) with outpatient follow-up

Synopsis:
Approximately 15% of patients receiving CPR for cardiac arrest in the hospital survive to discharge. But what happens after they go home, especially to the elderly? This study linked data from a large registry of episodes of in-hospital CPR with data from Medicare. They identified 6972 adults who were 65 years or older at the time of their index cardiac arrest (between 2000 and 2008). The average age of patients was 76 years, and 55% were men (odd, if you think about it, since there is a preponderance of women alive at that age). The distribution by race was similar to that in the country as a whole. The initial rhythm was asystole or pulseless electrical activity for 54%, ventricular tachycardia for 16%, and ventricular fibrillation for 30%. Approximately half went home with mild (34%), moderate (14%), or severe (3%) neurologic impairment. Unadjusted 1-year survival was 64% for those 65 to 74 years old, 57% for those 75 to 84 years old, and 45% for those 85 years and older. Survival was similar for men and women, but higher for Whites than non-Whites. Survival was strongly influenced by the neurologic status at discharge, ranging from 73% for those with no or minimal impairment to 35% for those with moderate impairment, and only 8% for those with severe impairment or coma. Three-year survival was 44%, and the authors point out that this is similar to the survival following hospitalization for heart failure in the elderly.

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