Clinical Outcomes and Applicability of Emergency Department Termination-of-Resuscitation Rules in Super-Elderly...

Introduction: The global aging population has led to a rapid increase in patients aged ≥ 80 years experiencing out-of-hospital cardiac arrest (OHCA). This study used data from three domestic university hospitals to analyze the clinical characteristics and prognoses of elderly patients and evaluate the validity of age-based criteria for termination of resuscitation (TOR). Methods: This study included 1234 adult patients with nontraumatic OHCA who presented to the emergency departments of three hospitals between 2015 and 2021. The patients were categorized as non-elderly (<65 years), elderly (65-79 years), or super-elderly (≥80 years), and outcomes, including return of spontaneous circulation (ROSC), survival to discharge, and favorable neurological outcomes (Cerebral Performance Category 1-2), were analyzed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) with Wilson 95% confidence intervals (CIs), and the area under the ROC curve (AUC) of the W-/D-/R- (unwitnessed/non-shockable/no prehospital ROSC) rule were calculated for both the full cohort and the super-elderly subgroup. Results: The super-elderly patients (n = 466) had significantly lower rates of ROSC, survival to discharge, and favorable neurological outcomes than the other age groups. Multivariate analysis revealed that extreme old age was a strong negative predictor of favorable neurological outcomes. For super-elderly patients as a whole (n = 466), the survival rate was only 2.4%, and the favorable neurological outcome rate was only 0.6%. Conclusions: Although the prognosis for super-elderly patients with OHCA is extremely poor, the possibility of survival is not entirely "zero." Therefore, applying a multifactorial ED TOR rule that comprehensively considers whether the arrest was witnessed, the initial rhythm, and whether on-scene ROSC occurred, rather than relying solely on age criteria, would be more rational and aid in ethical decision-making.