Clinical Epidemiology and Ageing

Management and outcomes of cardiac arrests at nursing homes: A French nationwide cohort study.

Vaux J, Lecarpentier E, Heidet M, Oubaya N, Hubert H, Baert V, Segal N, Mansouri N, Gueugniaud P-Y, Bertrand C, Canoui-Poitrine F Resuscitation. 2019;140:86-92.

BACKGROUND: The incidence of cardiac arrest (CA) in nursing homes is rising. Our objective was to compare nursing home CAs with at-home CAs in patients aged 65 and over with regard to the CAs' characteristics, the use and characteristics of cardiopulmonary resuscitation (CPR), and the outcome.

METHODS: We performed an ancillary analysis of a French nationwide cohort of over-65 patients having experienced an out-of-hospital CA (at home or in a nursing home) treated by a physician-manned mobile intensive care unit (MICU) between July 2011 and September 2015.

RESULTS: Out of 21,720 CAs, 1907 (9%) occurred in a nursing home. The presence of a witness was more frequent in the nursing home than at home (77% vs. 62%, respectively; p < 0.001) and bystander-initiated CPR was more frequent (62% vs. 34%, respectively; p < 0.001). CPR by a MICU was less likely in the nursing home than at home - even after adjustment for the patients' and CAs' characteristics (adjusted odds ratio (aOR) [95% confidence interval] = 0.49 [0.42-0.57]). A return of spontaneous circulation was less frequent in the nursing home than at home (14% vs. 16%, respectively; OR = 0.86 [0.75-0.99]; p = 0.03) except when CPR was performed by the MICU (31% vs. 26%, respectively; OR = 1.25 [1.07-1.47]; p = 0.005). There was no intergroup difference in the CA outcome at day 30.

CONCLUSIONS: Nursing home residents who experience a CA are less likely to receive CPR from a MICU. If CPR is performed, however, the residents' prognosis is no worse than that of patients treated at home.

MeSH terms: Age Factors; Aged; Aged, 80 and over; Cardiopulmonary Resuscitation; Cohort Studies; Female; France; Humans; Intensive Care Units; Male; Mobile Health Units; Multivariate Analysis; Nursing Homes; Out-of-Hospital Cardiac Arrest; Terminally Ill; Time Factors
DOI: 10.1016/j.resuscitation.2019.05.016