Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile

TY - JOUR

T1 - Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile

AU - Søholm, Helle

AU - Bro-Jeppesen, John

AU - Lippert, Freddy K

AU - Køber, Lars

AU - Wanscher, Michael

AU - Kjaergaard, Jesper

AU - Hassager, Christian

N1 - Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

PY - 2014/3

Y1 - 2014/3

N2 - Background: Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years, and new data are therefore needed to avoid unsubstantiated statements when debating futility of resuscitation attempts following OHCA in nursing home (NH)-residents. We aimed to investigate the outcome and prognosis after OHCA in NH. Methods: Consecutive Emergency Medical Service (EMS) attended OHCA-patients in Copenhagen during 2007-2011 were included. Utstein-criteria for pre-hospital data and review of individual patient charts for in-hospital post-resuscitation care were collected. Results: A total of 2541 consecutive OHCA-patients were recorded, 245 (10%) of who were current NH-residents. NH-patients were older, more frequently female, had more witnessed arrests, fewer shockable primary rhythm and assumed cardiac aetiology, but shorter time to the return of spontaneous circulation (ROSC) compared to OHCA in non-nursing homes (non-NH). Overall 30-day survival rate was 9% in NH and 18% in non-NH, p< 0.001. Of the 245 NH-arrests 79 (32%) patients were admitted to hospital compared to 937 (41%) from non-NH (p< 0.001). Thirty-day survival rate in patients admitted to hospital were 27% for NH- and 42% for non-NH-patients, p< 0.001. OHCA in NH was, however, not associated with a significantly worse prognosis (HR. = 0.88 (0.64-1.21), p= 0.4) after adjustment for known prognostic factors including co-morbidity. Conclusions: Nursing home residents resuscitated from OHCA and admitted to hospital have similar survival rates as non-NH-patients when adjusting for known prognostic factors and pre-existing co-morbidity. A policy of not attempting resuscitation in nursing homes at all may therefore not be justified.

AB - Background: Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years, and new data are therefore needed to avoid unsubstantiated statements when debating futility of resuscitation attempts following OHCA in nursing home (NH)-residents. We aimed to investigate the outcome and prognosis after OHCA in NH. Methods: Consecutive Emergency Medical Service (EMS) attended OHCA-patients in Copenhagen during 2007-2011 were included. Utstein-criteria for pre-hospital data and review of individual patient charts for in-hospital post-resuscitation care were collected. Results: A total of 2541 consecutive OHCA-patients were recorded, 245 (10%) of who were current NH-residents. NH-patients were older, more frequently female, had more witnessed arrests, fewer shockable primary rhythm and assumed cardiac aetiology, but shorter time to the return of spontaneous circulation (ROSC) compared to OHCA in non-nursing homes (non-NH). Overall 30-day survival rate was 9% in NH and 18% in non-NH, p< 0.001. Of the 245 NH-arrests 79 (32%) patients were admitted to hospital compared to 937 (41%) from non-NH (p< 0.001). Thirty-day survival rate in patients admitted to hospital were 27% for NH- and 42% for non-NH-patients, p< 0.001. OHCA in NH was, however, not associated with a significantly worse prognosis (HR. = 0.88 (0.64-1.21), p= 0.4) after adjustment for known prognostic factors including co-morbidity. Conclusions: Nursing home residents resuscitated from OHCA and admitted to hospital have similar survival rates as non-NH-patients when adjusting for known prognostic factors and pre-existing co-morbidity. A policy of not attempting resuscitation in nursing homes at all may therefore not be justified.

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Nursing Homes

KW - Out-of-Hospital Cardiac Arrest

KW - Resuscitation

KW - Retrospective Studies

KW - Survival Rate

U2 - 10.1016/j.resuscitation.2013.10.033

DO - 10.1016/j.resuscitation.2013.10.033

M3 - Journal article

C2 - 24269866

SN - 0300-9572

VL - 85

SP - 369

EP - 375

JO - Resuscitation

JF - Resuscitation

IS - 3

ER -