Abstract Body: Background: In older patients with out-of-hospital cardiac arrest (OHCA), the neurological outcome could differ based on bystander type and age.
Hypothesis: Distinct strategies for increasing or withholding bystander cardiopulmonary resuscitation (BCPR) for older patients with OHCA are required based on bystander type and age.
Aim: To propose distinct strategies based on bystander type and age.
Methods: The outcomes of 322,943 older patients with OHCA of cardiac origin witnessed by a citizen bystander (age ≥65 years) from the prospectively recorded All-Japan Utstein Registry between 2005 and 2022 were analyzed. Patients were assigned to one of three groups by age (65–74, 75–89, or ≥90 years). The bystander type was classified as family member, friend, colleague, passerby, or other. The annual rates of BCPR and 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1 or 2, were evaluated.
Results: The rates of patients witnessed by family member and witnessed by composite of friend, colleague, and passerby, in the 65–74, 75–89, and ≥90 years age groups, decreased with increasing age (67.5%, 68.4%, and 54.5%, and 16.2%, 5.9%, and 1.7%; p for trend < 0.001, respectively). The rate of patients witnessed by others increased with increasing age (16.3%, 25.7%, and 43.8%, respectively; p for trend < 0.001). During the study period, the annual rate of BCPR and 1-month CPC 1–2 in patients witnessed by family member significantly improved in all age groups (p for trend < 0.001, respectively). However, the rate of BCPR remained at approximately 50% in all age groups (Table 1). For OHCA witnessed by others, the annual rate of BCPR significantly improved in all age groups (p for trend < 0.001, respectively). The annual rate of 1-month CPC 1–2 significantly improved in the aged 65–74 years group (p for trend < 0.05) but not in the 75–89 years group. In the ≥90 years group, the rate of BCPR reached approximately 80%, but the rate of 1-month CPC 1–2 did not improve and remained less than 1% (Table 2).
Conclusions: For older patients with OHCA witnessed by family members, the further increase in the rate of BPCR could result in an improvement in the neurological outcome. In the ≥90 years group witnessed by others, most bystanders were presumed to be staff, and the patients were presumed to be residents of a nursing home. For those patients, withholding BCPR based on advance care planning is required to reduce futile resuscitation.