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.

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