Surviving In-Hospital Cardiac Arrest and the Role of Age

Background: There is limited data on the predictors of outcomes in patients who have in-hospital cardiac arrest. This study aims to understand the factors that might affect the survival from the cardiac arrest and survival-to-discharge after in-hospital cardiac arrest.

Methods: Institutional review board of the Cleveland Clinic approved the retrospective cross-sectional study for patients who had in-hospital cardiac arrest from March 2015 to June 2016 in Fairview Hospital, Cleveland. Cardiac arrest (CA) protocol was activated on 153 patients during the study period. Out of 153 patients, 21 were false activation and they were excluded. Data was collected using the electronic medical record for events before, during and after the CA for patient that survived. SPSS was used for statistical analysis.

Results: Total of 132 patients were included in the study (n=132). Demographic distribution showed mean age of 67.9 years and median age was 69.5 years, 59% (78/132) were males, 51% (67/132) had diabetes, 78% (103/132) had hypertension, 46% (61/132) had coronary artery disease, 39% (51/132) had chronic kidney disease and 38% (50/132) had COPD. Return of Spontaneous Circulation (ROSC) was achieved in 76/132 (57.6%) patient and 34/76 (44.7%) of those that survived were eventually discharged. A sub-group analysis was done after dividing the 132 patients into those less than 80 (98 patients) and those above age 80 (34 patients). ROSC was achieved in 63% (62/98) of patients with age <80 and 41% (14/34) in age >80 (p=0.025). Survival-to-discharge after ROSC was 46.8% (29/62) in patients with age <80 (p<0.0001) and 35.7% (5/14) in patients with age 80 or more (p=0.007). When age was split into decades and re-analyzed; survival-to-discharge after ROSC was 8/22 (36.4%) in fifth decade or younger (p=0.008), 11/18 (61.1%) in sixth decade (p=0.001), 10/22 (45.5%) in the seventh decade (p=0.01), 4/13 (30.8%) in the eighth decade (p=0.035) and 1/1 in ninth decade (p=0.167).

Conclusions: ROSC and survival-to-discharge are worse in patients with the age 80 or more. The observed trend was that with minor exceptions as the age increased, the survival decreases. Further studies with ample power to properly analyze and adjust for confounding variables are needed to delineate outcomes in patients suffering in hospital cardiac arrest.