Analysis of effective out-of-hospital resuscitations in the elderly

Radoslaw Owczuk¹, Magdalena Anna Wujtewicz¹, Wioletta Sawicka¹, Maria Wujtewicz¹, Arkadiusz Piankowski¹, Barbara Kwiecinska¹, Agnieszka Markul², Ewa Januszewska-Michalak², Iwona Bednarska-Zytko³, Barbara Skoczylas-Stoba³, Irena Burdak⁴

Summary
In this paper we present the results of a questionnaire study concerning out-of-hospital resuscitations performed on the elderly (> 70 years of age). Included were 69 cases of cardiac arrest. The mean patient age was 74.6 yrs; men were more numerous than women (60.9% vs. 39.1%). The most common cause of circulation arrest was ventricular fibrillation. We analysed the patients´ state on their admission to hospital, as well as the outcomes. Most patients died a short time after admission to hospital. Of the analysed patients 7,2% survived for a period longer than 12 months.
Cardiac arrest in elderly persons is often perceived as a natural ending of their lives, particularly in those with chronic ailments. Resuscitating these patients may be considered as a treatment which is unnecessary or is fated to fail. Previous reports on cardiopulmonary resuscitation (CPR) in the geriatric population have presented different opinions from those included in the current standards and guidelines on resuscitation (1). This policy causes many physicians to initiate the reanimation of elderly patients very reluctantly. However, the DNR "do not resuscitate” rule, which is in force in some countries, concerns only selected cases of hospitalised patients, and may be applied after a scrupulous analysis of all the pros and cons of reanimation by a special committee. In no case does rule apply this to out-of-hospital reanimations, where another rule ("first rescue, then ask”) should be obeyed (2).
Current publications concerning restrictions on resuscitation include only such conditions as decapitation, body charring or decay, or the presence of rigor mortis, but do not include the patient´s age (3, 4). The aforementioned ”unwillingness” to start resuscitating elderly persons with cardiac arrest (CA) may also be caused by the rescuers´ opinions on whether or not the short– and long-term CPR outcomes in these patients will be satisfactory. Analysis of references published in English does not support these doubts univocally, and there are no publications from Polish sources. The specificity of the Polish healthcare system, due to society´s low level of education on basic (non-instrumental) life support, and to the ever-developing medical rescue system, may result in different findings from those concerning more highly-developed countries. Therefore, analysis was covered out-of-hospital cardiopulmonary resuscitations which were judged effective in persons of over 70 years of age.

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