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Bystander CPR and Long-Term Survival in Older Adults With Out-of-Hospital Cardiac Arrest
Paul S Chan1, Robert Merritt2, Bryan McNally3
1Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA.
Insights
Bystander cardiopulmonary resuscitation (CPR) significantly improves survival for older adults experiencing out-of-hospital cardiac arrest (OHCA). This life-saving intervention enhances both immediate hospital survival and long-term mortality outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Limited research exists on the long-term survival impact of bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA).
- Previous studies primarily focused on in-hospital or short-term survival rates following OHCA.
Purpose of the Study:
- To investigate the association between bystander CPR and long-term survival outcomes in older adults with OHCA.
- To determine if bystander CPR influences mortality rates beyond hospital discharge.
Main Methods:
- Analysis of 152,653 patients aged 65+ with OHCA from the Cardiac Arrest Registry to Enhance Survival.
- Used multivariable logistic regression for in-hospital survival and Cox regression for 5-year mortality among survivors linked to Medicare.
- Examined survival associations stratified by age groups (65-74, 75-84, 85+).
Main Results:
- Bystander CPR was associated with a 24% higher likelihood of surviving to hospital discharge (10.2% vs 5.5%).
- The survival benefit of bystander CPR was consistent across all age groups (65-74, 75-84, and 85+).
- Among hospital survivors, bystander CPR was linked to a 22% reduction in long-term mortality over a median follow-up of 31 months (adjusted hazard ratio: 0.78).
Conclusions:
- Bystander CPR significantly increases in-hospital survival rates for older adults with OHCA.
- The positive survival impact of bystander CPR persists and even magnifies after hospital discharge, despite competing mortality risks.
- These findings underscore the critical importance of bystander CPR in improving long-term outcomes for elderly cardiac arrest patients.
Background:
Most studies on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) have focused on in-hospital or short-term survival.
Objectives:
The purpose of this study was to examine the association between bystander CPR and long-term survival outcomes for OHCA.
Methods:
Within the Cardiac Arrest Registry to Enhance Survival, we identified 152,653 patients with OHCA ≥65 years of age or older. Using multivariable hierarchical logistic regression, we first examined the association between bystander CPR and in-hospital survival. Then, among those surviving to discharge and linked to Medicare files, we evaluated the association between bystander CPR and long-term mortality over 5 years using multivariable Cox regression.
Results:
Overall, 58,464 (38.3%) received bystander CPR. Patients receiving bystander CPR were more likely to have an OHCA that was witnessed, in a public location, and with an initial shockable rhythm. Bystander CPR was associated with a 24% higher likelihood of surviving to hospital discharge (10.2% vs 5.5%; adjusted relative risk: 1.24 [95% CI: 1.19-1.29]; P < 0.001), and this survival benefit was similar (interaction P = 0.24) for those who were 65 to 74, 75 to 84, and ≥85 years of age. Among patients surviving to hospital discharge (median follow-up of 31 months), bystander CPR was additionally associated with lower long-term mortality vs those without bystander CPR (adjusted hazard ratio: 0.78 [95% CI: 0.73-0.84]; P < 0.001), and this benefit was also consistent across age groups (interaction P = 0.13).
Conclusions:
In older adults with OHCA, bystander CPR was associated with higher rates of in-hospital survival. This survival benefit was not attenuated by competing mortality risks but increased in magnitude after hospital discharge.
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