• Andrew Fw Ho, Kai Yi Lee, Xinyi Lin, Ying Hao, Nur Shahidah, Yih Yng Ng, Benjamin Sh Leong, Ching Hui Sia, Benjamin Yq Tan, Ai Meng Tay, Marie Xr Ng, Han Nee Gan, Desmond R Mao, Michael Yc Chia, Si Oon Cheah, and Marcus Eh Ong.
• Health Services and Systems Research, Duke-NUS Medical School, Singapore.
• Ann Acad Med Singap. 2020 May 1; 49 (5): 285-293.

IntroductionNursing home (NH) residents with out-of-hospital cardiac arrests (OHCA) have unique resuscitation priorities. This study aimed to describe OHCA characteristics in NH residents and identify independent predictors of survival.Materials And MethodsOHCA cases between 2010-16 in the Pan-Asian Resuscitation Outcomes Study were retrospectively analysed. Patients aged <18 years old and non-emergency cases were excluded. Primary outcome was survival at discharge or 30 days. Good neurological outcome was defined as a cerebral performance score between 1-2.ResultsA total of 12,112 cases were included. Of these, 449 (3.7%) were NH residents who were older (median age 79 years, range 69-87 years) and more likely to have a history of stroke, heart and respiratory diseases. Fewer NH OHCA had presumed cardiac aetiology (62% vs 70%, P <0.01) and initial shockable rhythm (8.9% vs 18%, P <0.01), but had higher incidence of bystander cardiopulmonary resuscitation (74% vs 43%, P <0.01) and defibrillator use (8.5% vs 2.8%, P <0.01). Non-NH (2.8%) residents had better neurological outcomes than NH (0.9%) residents (P <0.05). Factors associated with survival for cardiac aetiology included age <65 years old, witnessed arrest, bystander defibrillator use and initial shockable rhythm; for non-cardiac aetiology, these included witnessed arrest (adjusted odds ratio [AOR] 3.8, P <0.001) and initial shockable rhythm (AOR 5.7, P <0.001).ConclusionNeurological outcomes were poorer in NH survivors of OHCA. These findings should inform health policies on termination of resuscitation, advance care directives and do-not-resuscitate orders in this population.

14 keywords...

hide…