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Good outcome in octogenarians after ventricular fibrillation out-of-hospital cardiac arrest

Introduction

Mild induced hypothermia (MIH) in comatose survivors of out-of-hospital cardiac arrest (OHCA) is highly recommended [1, 2]. Still, there is great uncertainty when it comes to age limits for the therapy as the initial randomised studies excluded the majority of patients over 75 years of age.

Methods

We retrospectively studied 115 OHCA survivors that were treated with MIH in our ICU from 2002 to 2008 with regard to cerebral performance category (CPC) at hospital discharge. Inclusion criteria were the same as in the Hypothermia after Cardiac Arrest Study Group except for the age limits. Bad outcome was defined as severe disability (CPC3), vegetative state (CPC4) and death (CPC5).

Results

Bad outcome was significantly more frequent in patients older than 60 years (chi-square P = 0.003), but even in patients older than 80 years we had good outcome in more than 50% of cases. The neurological outcome according to the different age groups is displayed in Figure 1.

Figure 1
figure1

Outcome according to age group after ventricular fibrillation OHCA and MIH (n = 115).

Conclusion

Although age seems to influence outcome, we found a surprisingly high incidence of good outcome even in the oldest comatose survivors after ventricular fibrillation OHCA treated with MIH. Hence, our data do not support a limitation of neurointensive care based on age alone.

References

  1. 1.

    Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al.: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002, 346: 557-563. 10.1056/NEJMoa003289

  2. 2.

    Hypothermia after Cardiac Arrest Study Group: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002, 346: 549-556. 10.1056/NEJMoa012689

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Busch, M., Søreide, E. Good outcome in octogenarians after ventricular fibrillation out-of-hospital cardiac arrest. Crit Care 13, P66 (2009). https://doi.org/10.1186/cc7230

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Keywords

  • Emergency Medicine
  • Cardiac Arrest
  • Hospital Discharge
  • Randomise Study
  • Ventricular Fibrillation