Original Contribution
Characteristics of cardiac arrest and resuscitation by age group: an analysis from the Swedish Cardiac Arrest Registry

https://doi.org/10.1016/j.ajem.2007.03.008Get rights and content

Abstract

Aim

The objective of this study was to describe patients who experienced an out-of-hospital cardiac arrest (OHCA) by age group.

Methods

All patients who suffered from an OHCA between 1990 and 2005 and are included in the Swedish Cardiac Arrest Registry (n = 40,503) were classified into the following age groups: neonates, younger than 1 year; young children, between 1 and 4 years; older children, between 5 and 12 years; adolescents, between 13 and 17 years; young adults, between 18 and 35 years; adults not retired, between 36 and 64 years; adults retired, between 65 and 79 years; and older adults, 80 years or older.

Results

Ventricular fibrillation was lowest in young children (3%) and highest in adults (35%). Survival to 1 month was lowest in neonates (2.6%) and highest in older children (7.8%). Children (<18 years), young adults (18-35 years), and adults (>35 years) survived to 1 month 24.5%, 21.2%, and 13.6% of cases, respectively (P = .0003 for trend) when found in a shockable rhythm. The corresponding figures for nonshockable rhythms were 3.8%, 3.2%, and 1.6%, respectively (P < .0001 for trend).

Conclusions

There is a large variability in characteristics and outcome among patients in various age groups who experienced an OHCA. Among the large age groups, there was a successive decline in survival with increasing age in shockable and nonshockable rhythms.

Introduction

A number of studies have shown that the etiologies behind cardiac arrest in children and young adults differ from those in adults [1], [2], [3], [4], [5], [6], [7], [8].

However, as far as we know, there are only few previous reports in which patients in various age groups were compared within the same database with regard to characteristics and outcome when the full spectrum of ages was included in the analyses [9].

So far, it has been difficult to compare survival between children and young adults, simply because the number of patients younger than 35 years who experience a cardiac arrest is so limited compared with that of patients aged 35 years or older. The study by Engdahl et al [9] should therefore be regarded as a pilot study for this first large-scale study ever to be performed that attempted to determine survival after out-of-hospital cardiac arrest (OHCA) in relation to the full spectrum of age groups.

This survey aimed to describe characteristics and outcome by age group among patients who experienced an OHCA when the whole spectrum of ages was included in the analyses. We previously reported from this database using the following age groups: younger than 65 years; between 65 and 75 years; and older than 75 years [10]. Whereas that survey focused on survival among elderly patients as compared with patients younger than 65 years, this survey focused on children and young adults as compared with adults in total and when various subgroups according to age were included in the analyses.

Section snippets

Patients

Patients who experienced a cardiac arrest for which an ambulance was called were included in the Swedish Cardiac Arrest Registry, with the exception of patients who had obviously been dead for a long time and whose bodies were therefore not taken to the hospital by the ambulance crew. For all other patients, a standardized form was completed by the ambulance crew.

Registry

This study was based on material collected by the Swedish Cardiac Arrest Registry, which is a joint venture between the Federation of

Results

Between January 1, 1990, and December 31, 2005, there were 49,815 patients in the registry. Of these patients, 9312 (19%) did not receive CPR. Among the remaining 40,503 patients, information on age was missing in 1658 (4%). This survey deals with the remaining 38,845 patients.

Discussion

This study gives an overall perspective of characteristics and outcome in OHCA when all age groups are considered. Because such an analysis on such a large sample size has not been done before, most of the data presented are new.

Conclusions

In analyzing patients who have experienced an OHCA in various age groups, there is a large variability in terms of etiology, patient characteristics, and patient outcome. Moreover, among patients younger than 18 years, different age groups with various outlooks can be defined. However, in comparing patients younger than 18 years, those aged between 18 and 35 years, and those older than 35 years, there is a successive decline in survival among patients found in shockable and nonshockable rhythms.

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This study was supported by grants from the Swedish National Board of Health and Welfare (Stockholm, Sweden).

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