Archives of Gerontology and Geriatrics 93 (2021) 104317 Available online 2 December 2020 0167-4943/© 2020 Elsevier B.V. All rights reserved. Age, pre-arrest neurological condition, and functional status as outcome predictors in out-of-hospital cardiac arrest: Secondary analysis of the Jerusalem Cohort Study data Esther-Lee Marcus a, b, * , Pavel Chigrinskiy a, b , Lisa Deutsch c , Sharon Einav b, d a Chronic Ventilator Dependent Division, Herzog Medical Center, Jerusalem, Israel b School of Medicine, Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel c BioStats Statistical Consulting Ltd., Modiin, Israel d Intensive Care Unit, Shaare-Zedek Medical Center, Jerusalem, Israel A R T I C L E INFO Keywords: Activities of daily living Cerebral performance category Cohort study Long-term survival Short-term survival Resuscitation ABSTRACT Purpose: Investigate the relation between age, baseline neurological and functional status, and survival after out- of-hospital cardiac arrest (OHCA). Methods: Data analysis from the Jerusalem District Resuscitation Study. Patients >80 years and those 18–80 years with OHCA from 4/2005–12/2010 were compared. Primary outcome: survival at four time points; secondary outcomes: neurological and functional status at hospital discharge, and relationship between survival, age and pre-arrest activities of daily living (ADL) and Cerebral Performance Category (CPC) scores (higher scores indicate worse function in both). Results: 3,211 patients (1,259 >80 years, 1952 aged 18–80) with median follow-up 5.9 years (range 0.1–11.1 years) were included. Survival was better for younger patients at all four time points, including 7.8% versus 2.5% at hospital discharge, 4.6% versus 0.2% at late follow-up. Functional status at discharge was also better, 4.8 ± 5.4 versus 9.0 ± 4.7, p<0.001, and more young patients had CPC1/2, 60.7% versus 32.2%, p = 0.004. Older patients who survived to emergency department admission had increased mortality per year of age (2.6%, hazard ratio [HR] 1.026, 95% confdence interval [CI] 1.006–1.048 versus 1.7%, HR 1.017, 95% CI 1.010–1.025), per point in pre-arrest ADL (3.0%, HR 1.030, 95% CI 1.007–1.054 versus 5.8%, HR 1.058, 95% CI 1.036–1.080), and per point in pre-arrest CPC (24%, HR 1.242, 95% CI 1.097–1.406 versus 37%, HR 1.370 95% CI 1.232–1.524). Conclusion: Patient independence before arrest may be a more crucial determinant of resuscitation outcome than older age alone. Discussion of end-of-life preferences is particularly important for older individuals with func- tional and cognitive decline. 1. Introduction The saying “Good ethics begin with good facts” (Loewy, 2007) is as pertinent to cardiopulmonary resuscitation as it is to other medical de- cisions. Reluctance towards withholding and withdrawal of care is, however, very much culturally embedded. Such practice may be accompanied by a signifcant societal burden, both economic and emotional (Ginsberg, Kark, & Einav, 2015). Hence, the importance of providing strong evidence to support medical decisions with regard to end-of-life decisions. The average patient undergoing out-of-hospital cardiac arrest and cardiopulmonary resuscitation in published series from Europe and the US is 65–70 years old (Andersen et al., 2015; Grasner et al., 2016; Ong et al., 2015). In other words, a large majority of patients undergoing cardiopulmonary resuscitation are older adults. The European 2015 Resuscitation Council Guidelines for Resuscita- tion recommend that decisions regarding cardiopulmonary resuscitation should not be made based on a single element such as age (Bossaert et al., 2015). While it is true that there is no age threshold above which there is an all-encompassing order for no cardiopulmonary resuscita- tion, it is also obvious that increasing age is accompanied by an increasing load of co-morbidity and functional and cognitive impair- ment. Several studies have compared the outcomes of cardiopulmonary * Corresponding author at: Chronic Ventilator Dependent Division, Herzog Medical Center, Jerusalem, POB 3900, Jerusalem 91035, Israel. E-mail addresses: estherlee@herzoghospital.org, elm@zahav.net.il (E.-L. Marcus), pavel@herzoghospital.org (P. Chigrinskiy), lisa@ldbiostats.com (L. Deutsch), einav_s@szmc.org.il (S. Einav). Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger https://doi.org/10.1016/j.archger.2020.104317 Received 22 October 2019; Received in revised form 29 November 2020; Accepted 30 November 2020