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

Julien Vaux; Eric Lecarpentier; Matthieu Heidet; Nadia Oubaya; Hervé Hubert; Valentine Baert; Nicolas Segal; Nadia Mansouri; Pierre-Yves Gueugniaud; Catherine Bertrand; Florence Canoui-Poitrine; on behalf GR-RéAC

doi:10.1016/j.resuscitation.2019.05.016

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

Resuscitation. 2019 Jul:140:86-92. doi: 10.1016/j.resuscitation.2019.05.016. Epub 2019 May 23.

Affiliations

¹ Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU94, F-94000 Créteil, France; Université Paris-Est Créteil, EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), F-94000 Créteil, France. Electronic address: julien.vaux@aphp.fr.
² Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU94, F-94000 Créteil, France.
³ Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU94, F-94000 Créteil, France; Université Paris-Est Créteil, EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), F-94000 Créteil, France.
⁴ Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, Département de Santé Publique, F-94000 Créteil, France.
⁵ Université de Lille, EA-2694 (Santé Publique: épidémiologie et qualité des soins), F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre électronique des Arrêts Cardiaques, F-59000, Lille, France.
⁶ Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
⁷ Département de Médecine d'Urgence, SAMU 69, Groupement hospitalier Edouard Herriot, F-69000, Lyon, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre électronique des Arrêts Cardiaques, F-59000, Lille, France.
⁸ Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, Département de Santé Publique, F-94000 Créteil, France; Université Paris-Est Créteil (UPEC), EA-7376 (Clinical Epidemiology and Ageing, CEpiA), F-94000, Créteil, France.
⁹ French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre électronique des Arrêts Cardiaques, F-59000, Lille, France.

PMID: 31129228
DOI: 10.1016/j.resuscitation.2019.05.016

Abstract

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.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Emergency medical services; Medical practices; Nursing home.

MeSH terms

Age Factors
Aged
Aged, 80 and over
Cardiopulmonary Resuscitation / statistics & numerical data*
Cohort Studies
Female
France / epidemiology
Humans
Intensive Care Units
Male
Mobile Health Units
Multivariate Analysis
Nursing Homes*
Out-of-Hospital Cardiac Arrest / mortality*
Out-of-Hospital Cardiac Arrest / therapy*
Terminally Ill
Time Factors