Relevance of Cardiopulmonary Resuscitation in Centenarian’s Out-of-Hospital Cardiac Arrest

Abstract

Rationale: The elderly population is growing year after year; especially individuals aged 90 and over. Centenarians account for a small proportion of out-of-hospital cardiac arrest (OHCA) victims. The CPR utility in this population is subject to debate and raises an ethical standpoint. Aims and Objectives: Our study aim is to determine characteristics associated with receipt of advanced life support (ALS) and with a return of spontaneous circulation (ROSC) among a cohort of centenarians with OHCA documented in the French National OHCA Registry (RéAC). Method: We included centenarians with OHCA recorded in the RéAC between 2011 and 2021. Clinical and demographic characteristics, OHCA context, care received, and survival were analysed. Primary outcome was the survival rate 30 days after the OHCA or upon discharge from hospital. Results: Of the 132 centenarians included, 17 had received ALS. ROSC was observed in 5 of the 17 cases. Basic life support (BLS) had been initiated by bystanders in 35.6% of cases and by firefighters in 69.2%. On arrival of the emergency medical team, asystole was noted in 91.3% of cases. Individuals having received ALS were more likely to have suffered from asphyxiation, electrocution, drowning, or an overdose (35.3%, vs. 10.5% of the non-ALS cases). Within the ALS group, ROSC was associated with the provision of BLS by bystanders (60.0%, vs. 50.0% of the cases without ROSC) or by firefighters (100.0% vs. 75.0%, respectively) and a shorter no-flow time (6 min vs. 11 min., respectively). None of the 132 included centenarians were alive 30 days after the OHCA. Conclusion: After OHCA in a centenarian, age appears to be a barrier to the ALS initiation but not the BLS initiation. The fact that none of the victims were alive 30 days after the OHCA raises ethical questions about the resuscitation utility for very elderly victims.