Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Ann Acad Med Singap. 2020 May;49(5):285-293.
Nursing 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.
OHCA 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.
A 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%, <0.01) and initial shockable rhythm (8.9% vs 18%, <0.01), but had higher incidence of bystander cardiopulmonary resuscitation (74% vs 43%, <0.01) and defibrillator use (8.5% vs 2.8%, <0.01). Non-NH (2.8%) residents had better neurological outcomes than NH (0.9%) residents ( <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, <0.001) and initial shockable rhythm (AOR 5.7, <0.001).
Neurological 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.
养老院（NH）中有院外心脏骤停（OHCA）的居民有独特的复苏重点。本研究旨在描述 NH 居民 OHCA 的特征，并确定生存的独立预测因素。
回顾性分析了 2010-16 年泛亚洲复苏结果研究中的 OHCA 病例。排除年龄<18 岁和非紧急情况的患者。主要结局为出院或 30 天的存活。良好的神经功能结局定义为脑功能评分 1-2 之间。
共纳入 12112 例患者。其中，449 例（3.7%）为 NH 居民，年龄较大（中位数年龄 79 岁，范围 69-87 岁），更有可能有中风、心脏和呼吸系统疾病的病史。NH OHCA 中推测为心脏病因的比例较低（62%对 70%，<0.01）和初始可除颤节律的比例较低（8.9%对 18%，<0.01），但旁观者心肺复苏（74%对 43%，<0.01）和除颤器使用（8.5%对 2.8%，<0.01）的发生率较高。非 NH（2.8%）居民的神经功能结局优于 NH（0.9%）居民（<0.05）。心脏病因的生存相关因素包括年龄<65 岁、目击者见证、旁观者使用除颤器和初始可除颤节律；非心脏病因的生存相关因素包括目击者见证（调整后的优势比[OR]3.8，<0.001）和初始可除颤节律（OR 5.7，<0.001）。
NH 院外心脏骤停幸存者的神经功能结局较差。这些发现应该为该人群的复苏终止、预先护理指令和不复苏指令的卫生政策提供信息。
