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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


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:


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.


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

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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.


1. Akahane M, Tanabe S, Koike S, Ogawa T, Horiguchi H, Yasunaga H, et al. Elderly out-of-hospital cardiac arrest has worse outcomes with a family bystander than a non-family bystander. Int J Emerg Med 2012;5:41.

2. Johnson NJ, Salhi RA, Abella BS, Neumar RW, Gaieski DF, Carr BG. Emergency department factors associated with survival after sudden cardiac arrest. Resuscitation 2013;84:292–97.

3. Hayakawa K, Tasaki O, Hamasaki T, Sakai T, Shiozaki T, Nakagawa Y, et al. Prognostic indicators and outcome prediction model for patients with return of spontaneous circulation from cardiopulmonary arrest: the Utstein Osaka Project. Resuscitation 2011;82:874–80.

4. Wampler DA, Collett L, Manifold CA, Velasquez C, McMullan JT. Cardiac arrest is rare without prehospital return of spontaneous circulation. Prehosp Emerg Care 2012;16:451–5.

5. Nolan JP, Deakin CD, Soar J, Böttiger BW, Smith G. European Resuscitation Council. European resuscitation council guidelines for resuscitation 2005. Section

4. Adult advanced life support. Resuscitation 2005;67:S39–86.

6. Azlan A, Nidzwani S. Factors predicting outcome of cardiopulmonary resuscitation among elderly Malaysians: a retrospective study. Med J Malaysia 2012;67:278–83.

7. Sladjana A. A prediction survival model for out-of-hospital cardiopulmonary resuscitations. J Crit Care 2011;26:e11–8.

8. Mosier J, Itty A, Sanders A, Mohler J, Wendel C, Poulsen J, et al. Cardiocerebral resuscitation is associated with improved survival and neurological outcome from out-of-hospital cardiac arrest in elders. Acad Emerg Med 2010;17:269–75.

9. Cocchi MN, Miller J, Hunziker S, Carney E, Salciccioli J, Farris S, et al. The association of lactate and vasopressor need for mortality prediction in survivors of cardiac arrest. Minerva Anesthesiol 2011;77:1–9.

10. Kim J, Kim K, Lee JH, Jo YH, Kim T, Rhee JE, et al. Prognostic implication of initial coagulopathy in out-of-hospital cardiac arrest. Resuscitation 2013;84:48–53.

11. Hasper D, von Haehling S, Storm C, Jörres A, Schefold JC. Changes in serum creatinine in the first 24 hours after cardiac arrest indicate prognosis: an observational cohort study. Crit Care 2009;13:R168.

12. Schefold JC, Storm C, Krüger A, Ploner CJ, Hasper D. The Glasgow Coma Scale is a predictor of good outcome in cardiac arrest patients treated with therapeutic hypothermia. Resuscitation 2009;80:658–61.

13. Ristagno G, Gullo A, Berlot G, Lucangelo U, Geheb E, Bisera J. Predictions of successful defibrillation in human victims of out-of-hospital cardiac arrest: a retrospective electrocardiographic analysis. Anaesth Intensive Care 2008;36:46–50.

14. Su YY, Yang QL, Pang Y, Lv XP. Evaluation of coma patients after cardiopulmonary resuscitation. Chin Med J 2005;118:1808–11.

15. Takase A, Sakamoto T, Okada Y. Arterial base excess after CPR: the relationship to CPR duration and characteristics related to outcome. Resuscitation 2007;73:394–9.

16. Levy DE, Caronna JJ, Singer BH, Lapinski RH, Frydman H, Plum F. Predicting outcome from hypoxic-ischemic coma. JAMA 1985;253:1420-6.

17. Ajam K, Gold LS, Beck SS, Damon S, Phelps R, Rea TD. Reliability of the cerebral performance category to classify neurological status among survivors of ventricular fibrillation arrest: a cohort study. Scand J Trauma Resusc Emerg Med 2011;19:38.

18. Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med 2005;45:524–8.

19. Odom SR, Howell MD, Silva GS, Nielsen VM, Gupta A, Shapiro NI, et al. Lactate clearance as a predictor of mortality in trauma patients. J Trauma Acute Care Surg 2013;74:999–1004.

20. del Portal DA, Shofer F, Mikkelsen ME, Dorsey PJ Jr, Gaieski DF, Goyal M, et al. Emergency department lactate is associated with mortality in older adults admitted with and without infections. Acad Emerg Med 2010;17:260–8.

21. Shinozaki K, Oda S, Sadahiro T, Nakamura M, Hirayama Y, Watanabe E, et al. Blood ammonia and lactate levels on hospital arrival as a predictive biomarker in patients with out-of-hospital cardiac arrest. Resuscitation 2011;82:404–9.

22. Bonnin MJ, Pepe PE, Clark PS Jr. Survival in the elderly after out-of-hospital cardiac arrest. Crit Care Med 1993;21:1645–51.

23. Scott PA, Barry J, Roberts PR, Morgan JM. Brain natriuretic peptide for the prediction of sudden cardiac death and ventricular arrhythmias: a meta-analysis. Eur J Heart Fail 2009;11:958–66.

24. Lin CH, Chi CH, Wu SY, Hsu HC, Chang YH, Huang YY, et al. Prognostic values of blood ammonia and partial pressure of ammonia on hospital arrival in out-of-hospital cardiac arrests. Am J Emerg Med 2013;31:8–15.

25. Annborn M, Dankiewicz J, Erlinge D, Hertel S, Rundgren M, Smith JG, et al. Procalcitonin after cardiac arrest – An indicator of severity of illness, ischemia –reperfusion injury and outcome. Resuscitation 2013;84:782–7.

26. Dankiewicz J, Linder A, Annborn M, Rundgren M, Friberg H. Heparin-binding protein: An early indicator of critical illness and predictor of outcome in cardiac arrest. Resuscitation 2013;84:935–9.

27. Marko N. Hypothermia during percutaneous coronary intervention in comatose survivors of cardiac care. SIGNA VITAE. 2010;5:13-6.

28. Einav S, Kaufman N, Algur N, Kark JD. Modeling serum biomarker S100 beta and neuron-specific enolase as predictors of outcome after out-of-hospital cardiac arrest: an aid to clinical decision making. J Am Coll Cardiol 2012;60:304–11.

29. Rothstein TL. Therapeutic hypothermia and reliability of somatosensory evoked potentials in predicting outcome after cardiopulmonary arrest. Neurocrit Care 2012;17:146–9.

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