anesthesiologist and intensivist, Director of Surgical Intensive Care, Shaare Zedek Medical Center and Associate Professor at the Hebrew University-Hadassah Faculty of Medicine, Ein-Kerem, Jerusalem, Israel.
anesthesiologist, Researcher at the Department of Surgical Oncological and Oral Science (Di.Chir.On.S.), University of Palermo; Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy.
Curr Opin Anaesthesiol. 2021 Feb 1;34(1):40-47. doi: 10.1097/ACO.0000000000000942.
To describe the epidemiology, prognostication, and treatment of out- and in-hospital cardiac arrest (OHCA and IHCA) in elderly patients.
Elderly patients undergoing cardiac arrest (CA) challenge the appropriateness of attempting cardiopulmonary resuscitation (CPR). Current literature suggests that factors traditionally associated with survival to hospital discharge and neurologically intact survival after CA cardiac arrest in general (e.g. presenting ryhthm, bystander CPR, targeted temperature management) may not be similarly favorable in elderly patients. Alternative factors meaningful for outcome in this special population include prearrest functional status, comorbidity load, the specific age subset within the elderly population, and CA location (i.e., nursing versus private home). Age should therefore not be a standalone criterion for withholding CPR. Attempts to perform CPR in an elderly patient should instead stem from a shared decision-making process.
An appropriate CPR attempt is an attempt resulting in neurologically intact survival. Appropriate CPR in elderly patients requires better risk classification. Future research should therefore focus on the associations of specific within-elderly age subgroups, comorbidities, and functional status with neurologically intact survival. Reporting must be standardized to enable such evaluation.
描述院外和院内心搏骤停（OHCA 和 IHCA）老年患者的流行病学、预后和治疗。
老年心搏骤停（CA）患者对是否进行心肺复苏（CPR）的适宜性提出了挑战。目前的文献表明，传统上与 CA 后出院生存率和神经功能完整生存率相关的因素（如初始节律、旁观者 CPR、目标温度管理）在老年患者中可能并不同样有利。对该特殊人群有意义的替代预后因素包括停搏前的功能状态、合并症负担、老年人群中特定的年龄亚组以及 CA 位置（即，疗养院与私人住宅）。因此，年龄不应作为单独的不进行 CPR 的标准。对老年患者进行 CPR 的尝试应源于共同的决策过程。
适当的 CPR 尝试是指导致神经功能完整存活的尝试。老年患者适当的 CPR 需要更好的风险分类。因此，未来的研究应侧重于特定的老年亚组、合并症和功能状态与神经功能完整存活的相关性。必须标准化报告，以进行此类评估。
