학술논문
Increasing neurologically intact survival after out-of-hospital cardiac arrest among elderly: Singapore Experience.
Document Type
Academic Journal
Author
Ong CA; Lee Kong Chian School of Medicine, Nanyang Technological University of Singapore, Singapore.; Nadarajan GD; Department of Emergency Medicine, Singapore General Hospital, Singapore.; Fook-Chong S; Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore.; Shahidah N; Department of Emergency Medicine, Singapore General Hospital, Singapore.; Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore.; Arulanandam S; Military Medicine Institute, Singapore Armed Forces Medical Corps, Singapore.; Ng YY; Lee Kong Chian School of Medicine, Nanyang Technological University of Singapore, Singapore.; Digital and Smart Health Office, Ng Teng Fong Centre for Healthcare Innovation, Tan Tock Seng Hospital, Singapore.; Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore.; Chia MY; Emergency Department, Tan Tock Seng Hospital, Singapore.; Tiah L; Accident & Emergency, Changi General Hospital, Singapore.; Mao DR; Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore.; Ng WM; Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore.; Leong BS; Emergency Medicine Department, National University Hospital, Singapore.; Doctor N; Department of Emergency Medicine, Sengkang General Hospital, Singapore.; Ong ME; Department of Emergency Medicine, Singapore General Hospital, Singapore.; Health Services & Systems Research, Duke-NUS Medical School, Singapore.; Siddiqui FJ; Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore.
Source
Publisher: Elsevier B.V Country of Publication: Netherlands NLM ID: 101774410 Publication Model: eCollection Cited Medium: Internet ISSN: 2666-5204 (Electronic) Linking ISSN: 26665204 NLM ISO Abbreviation: Resusc Plus Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Objectives: With more elderly presenting with Out-of-Hospital Cardiac Arrests (OHCAs) globally, neurologically intact survival (NIS) should be the aim of resuscitation. We aimed to study the trend of OHCA amongst elderly in a large Asian registry to identify if age is independently associated with NIS and factors associated with NIS.
Methods: All adult OHCAs aged ≥18 years attended by emergency medical services (EMS) from April 2010 to December 2019 in Singapore was extracted from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. Cases pronounced dead at scene, non-EMS transported, traumatic OHCAs and OHCAs in ambulances were excluded. Patient characteristics and outcomes were compared across four age categories (18-64, 65-79, 80-89, ≥90). Multivariable logistic regression analysis determined the factors associated with NIS.
Results: 19,519 eligible cases were analyzed. OHCA incidence increased with age almost doubling in octogenarians (from 312/100,000 in 2011 to 652/100,000 in 2019) and tripling in those ≥90 years (from 458/100,000 in 2011 to 1271/100,000 in 2019). The proportion of patients with NIS improved over time for the 18-64, 65-79- and 80-89-years age groups, with the greatest improvement in the youngest group. NIS decreased with each increasing year of age and minute of response time. NIS increased in the arrests of presumed cardiac etiology, witnessed and bystander CPR.
Conclusions: Survival with good outcomes has increased even amongst the elderly. Regardless of age, NIS is possible with good-quality CPR, highlighting its importance. End-of-life planning is a complex yet necessary decision that requires qualitative exploration with elderly, their families and care providers.
Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MEH Ong reports grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices. MEH Ong has a licensing agreement with ZOLL Medical Corporation and patent filed (Application no: 13/047,348) for a “Method of predicting acute cardiopulmonary events and survivability of a patient.” He is also the co-founder and scientific advisor of TIIM Healthcare, a commercial entity which develops real-time prediction and risk stratification solutions for triage. All other authors have no conflict of interest to disclose.
(© 2024 The Author(s).)
Methods: All adult OHCAs aged ≥18 years attended by emergency medical services (EMS) from April 2010 to December 2019 in Singapore was extracted from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. Cases pronounced dead at scene, non-EMS transported, traumatic OHCAs and OHCAs in ambulances were excluded. Patient characteristics and outcomes were compared across four age categories (18-64, 65-79, 80-89, ≥90). Multivariable logistic regression analysis determined the factors associated with NIS.
Results: 19,519 eligible cases were analyzed. OHCA incidence increased with age almost doubling in octogenarians (from 312/100,000 in 2011 to 652/100,000 in 2019) and tripling in those ≥90 years (from 458/100,000 in 2011 to 1271/100,000 in 2019). The proportion of patients with NIS improved over time for the 18-64, 65-79- and 80-89-years age groups, with the greatest improvement in the youngest group. NIS decreased with each increasing year of age and minute of response time. NIS increased in the arrests of presumed cardiac etiology, witnessed and bystander CPR.
Conclusions: Survival with good outcomes has increased even amongst the elderly. Regardless of age, NIS is possible with good-quality CPR, highlighting its importance. End-of-life planning is a complex yet necessary decision that requires qualitative exploration with elderly, their families and care providers.
Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MEH Ong reports grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices. MEH Ong has a licensing agreement with ZOLL Medical Corporation and patent filed (Application no: 13/047,348) for a “Method of predicting acute cardiopulmonary events and survivability of a patient.” He is also the co-founder and scientific advisor of TIIM Healthcare, a commercial entity which develops real-time prediction and risk stratification solutions for triage. All other authors have no conflict of interest to disclose.
(© 2024 The Author(s).)