Mads Wissenberg1, Fredrik Folke2, Carolina Malta Hansen2, Freddy K Lippert2, Kristian Kragholm2, Bjarke Risgaard2, Shahzleen Rajan2, Lena Karlsson2, Kathrine Bach Søndergaard2, Steen M Hansen2, Rikke Normark Mortensen2, Peter Weeke2, Erika Frischknecht Christensen2, Søren L Nielsen2, Gunnar H Gislason2, Lars Køber2, Christian Torp-Pedersen2. 1. From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.). Mads.Wissenberg.Joergensen@regionh.dk. 2. From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
Abstract
BACKGROUND: Survival after out-of-hospital cardiac arrest has increased during the last decade in Denmark. We aimed to study the impact of age on changes in survival and whether it was possible to identify patients with minimal chance of 30-day survival. METHODS AND RESULTS: Using data from the nationwide Danish Cardiac Arrest Registry (2001─2011), we identified 21 480 patients ≥18 years old with a presumed cardiac-caused out-of-hospital cardiac arrest for which resuscitation was attempted. Patients were divided into 3 preselected age-groups: working-age patients 18 to 65 years of age (33.7%), early senior patients 66 to 80 years of age (41.5%), and late senior patients >80 years of age (24.8%). Characteristics in working-age patients, early senior patients, and late senior patients were as follows: witnessed arrest in 53.8%, 51.1%, and 52.1%; bystander cardiopulmonary resuscitation in 44.7%, 30.3%, and 23.4%; and prehospital shock from a defibrillator in 54.7%, 45.0%, and 33.8% (all P<0.05). Between 2001 and 2011, return of spontaneous circulation on hospital arrival increased: working-age patients, from 12.1% to 34.6%; early senior patients, from 6.4% to 21.5%; and late senior patients, from 4.0% to 15.0% (all P<0.001). Furthermore, 30-day survival increased: working-age patients, 5.8% to 22.0% (P<0.001); and early senior patients, 2.7% to 8.4% (P<0.001), whereas late senior patients experienced only a minor increase (1.5% to 2.0%; P=0.01). Overall, 3 of 9499 patients achieved 30-day survival if they met 2 criteria: had not achieved return of spontaneous circulation on hospital arrival and had not received a prehospital shock from a defibrillator. CONCLUSIONS: All age groups experienced a large temporal increase in survival on hospital arrival, but the increase in 30-day survival was most prominent in the young. With the use of only 2 criteria, it was possible to identify patients with a minimal chance of 30-day survival.
BACKGROUND: Survival after out-of-hospital cardiac arrest has increased during the last decade in Denmark. We aimed to study the impact of age on changes in survival and whether it was possible to identify patients with minimal chance of 30-day survival. METHODS AND RESULTS: Using data from the nationwide Danish Cardiac Arrest Registry (2001─2011), we identified 21 480 patients ≥18 years old with a presumed cardiac-caused out-of-hospital cardiac arrest for which resuscitation was attempted. Patients were divided into 3 preselected age-groups: working-age patients 18 to 65 years of age (33.7%), early senior patients 66 to 80 years of age (41.5%), and late senior patients >80 years of age (24.8%). Characteristics in working-age patients, early senior patients, and late senior patients were as follows: witnessed arrest in 53.8%, 51.1%, and 52.1%; bystander cardiopulmonary resuscitation in 44.7%, 30.3%, and 23.4%; and prehospital shock from a defibrillator in 54.7%, 45.0%, and 33.8% (all P<0.05). Between 2001 and 2011, return of spontaneous circulation on hospital arrival increased: working-age patients, from 12.1% to 34.6%; early senior patients, from 6.4% to 21.5%; and late senior patients, from 4.0% to 15.0% (all P<0.001). Furthermore, 30-day survival increased: working-age patients, 5.8% to 22.0% (P<0.001); and early senior patients, 2.7% to 8.4% (P<0.001), whereas late senior patients experienced only a minor increase (1.5% to 2.0%; P=0.01). Overall, 3 of 9499 patients achieved 30-day survival if they met 2 criteria: had not achieved return of spontaneous circulation on hospital arrival and had not received a prehospital shock from a defibrillator. CONCLUSIONS: All age groups experienced a large temporal increase in survival on hospital arrival, but the increase in 30-day survival was most prominent in the young. With the use of only 2 criteria, it was possible to identify patients with a minimal chance of 30-day survival.
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