Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Centre de recherche du CHU de Québec, Québec, Canada; The Alfred Hospital, Melbourne, Australia.
Resuscitation. 2018 May;126:118-124. doi: 10.1016/j.resuscitation.2018.03.017. Epub 2018 Mar 12.
Understanding the prognosis of elderly out-of-hospital cardiac arrest (OHCA) patients is vital to informing resuscitation and advanced care planning decisions. However, short-term outcomes such as survival to hospital discharge do not account for post-arrest quality of life. We describe the 12-month functional recovery and health-related quality of life (HR-QOL) of elderly OHCA survivors, including those arresting in aged care facilities.
We conducted a retrospective analysis of Victorian Ambulance Cardiac Arrest Registry data for all OHCA survivors to hospital discharge aged ≥65 years between 1 January 2010 and 30 June 2016. The influence of age on functional recovery and independent living was assessed using multivariable logistic regression.
During the study period, 20,103 elderly OHCAs were attended, 9016 (44.9%) of whom received a resuscitation attempt. In total, 876 (9.7%) patients survived to hospital discharge and 777 were alive 12 months post-arrest. Of these, 651 participated in 12-month follow-up (response rate 83.8%). Most (60.6%) resided at home without additional care and 66.6% reported a good functional recovery, however both measures decreased with increasing age (p < 0.001). Mental HR-QOL increased with increasing age and was significantly better than the age- and sex-matched Australian population. Each 10-year increase in age was associated with a 40.8% (95%CI 25.6-53.0%) reduction in the odds of good functional recovery, and a 65.8% (95%CI 55.8-73.5%) reduction in the odds of living independently. Of the 2575 OHCAs in an aged care facility, 2.2% survived to hospital discharge, however no patient reported a good 12-month functional recovery.
Most elderly OHCA survivors resided independently with good functionality 12 months post-arrest. However, increasing age was associated with less favourable outcomes. New strategies are needed with regard to resuscitation in aged care facilities.
了解老年院外心脏骤停（OHCA）患者的预后对于告知复苏和高级护理计划决策至关重要。然而，短期结果（如存活至出院）并不能说明心脏骤停后的生活质量。我们描述了老年 OHCA 幸存者的 12 个月功能恢复和健康相关生活质量（HR-QOL），包括在老年护理机构中发生心脏骤停的患者。
我们对 2010 年 1 月 1 日至 2016 年 6 月 30 日期间维多利亚救护车心脏骤停登记处所有 65 岁以上的 OHCA 幸存者至出院的数据进行了回顾性分析。使用多变量逻辑回归评估年龄对功能恢复和独立生活的影响。
在研究期间，共处理了 20,103 例老年 OHCA，其中 9016 例（44.9%）接受了复苏尝试。共有 876 例患者存活至出院，777 例患者在心脏骤停后 12 个月存活。其中，651 例患者参与了 12 个月的随访（应答率为 83.8%）。大多数（60.6%）患者居住在没有额外护理的家中，66.6%报告功能恢复良好，但这两个指标都随年龄的增加而下降（p<0.001）。精神 HR-QOL 随年龄的增加而增加，明显优于年龄和性别匹配的澳大利亚人群。每增加 10 岁，功能恢复良好的可能性就会降低 40.8%（95%CI 25.6-53.0%），独立生活的可能性就会降低 65.8%（95%CI 55.8-73.5%）。在 2575 例在老年护理机构发生的 OHCA 中，仅有 2.2%存活至出院，但没有患者报告 12 个月的功能恢复良好。
大多数老年 OHCA 幸存者在心脏骤停后 12 个月内独立生活，功能良好。然而，年龄的增加与预后较差有关。需要针对老年护理机构的复苏制定新策略。
