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Original Research

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Predictors of neurological outcome in the emergency department for elderly patients following out-of-hospital restoration of spontaneous circulation

  • KATSUHIRO NAGATA1
  • JUNYA TSURUKIRI2
  • KEIKO UENO1
  • SHIRO MISHIMA1

1Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center Shiro Mishima Emergency and Critical Care Medicine, Tokyo Medical University

2,Emergency and Critical Care Medicine Tokyo Medical University Hachioji Medical Center

DOI: 10.22514/SV101.042015.8 Vol.10,Issue 1,April 2015 pp.53-63

Published: 30 April 2015

*Corresponding Author(s): JUNYA TSURUKIRI E-mail: junya99@tokyo-med.ac.jp

Abstract

Aims. Survival rates for cardiac arrest in acute medicine are higher following out-of-hospital restoration of spontaneous circulation (OH-ROSC). However, data pertaining to OH-ROSC is limited in the elderly population. We aimed to assess the predictors of neurological outcome among elderly patients with OH-ROSC.

Methods. We retrospectively analyzed the data of patients 65 years and older who achieved OH-ROSC and who presented to the emergency department (ED) between 2009 and 2013. The following parameters were considered: age, sex, medical history, vital signs, blood values, initial electrical rhythm, witnessed cardiac arrest, bystander cardiopulmonary resuscitation, resuscitation duration, attempted defibrillation, and neurological outcome. Neurological outcomes were evaluated 3 months after cardiac arrest, using the cerebral performance category (CPC) score, and were classified into two groups: favorable outcome (CPC = 1–2) and unfavorable outcome (CPC = 3–5).

Results. Fifty-five patients were studied, of which 21 and 34 patients were classified as having favorable and unfavorable outcomes, respectively. The following values were associated with favorable outcomes: resuscitation duration, initial cardiac rhythm, base excess, pH, lactate levels, the motor response on the Glasgow Coma Scale (GCS), and the number of patients with GCS ≤8 (p < 0.01). Logistic regression analysis confirmed that motor response scores and lactate levels were independent predictors of neurological outcomes.

Conclusions. Lactate levels and GCS motor response measured immediately at ED arrival are likely to be useful to assess the neurological outcomes among elderly patients with OH-ROSC.

Keywords

age, basic life support, cardiac arrest, prediction, resuscitation

Cite and Share

KATSUHIRO NAGATA,JUNYA TSURUKIRI,KEIKO UENO,SHIRO MISHIMA. Predictors of neurological outcome in the emergency department for elderly patients following out-of-hospital restoration of spontaneous circulation. Signa Vitae. 2015. 10(1);53-63.

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