Jiang Elan, Raj Rohan, Sherrod Charles, Nguyen Dan, Kennedy Kevin, Chan Paul S
Yale University, New Haven, United States.
Pembroke Hill High School, Kansas City, MO, United States.
Resusc Plus. 2025 Feb 17;22:100908. doi: 10.1016/j.resplu.2025.100908. eCollection 2025 Mar.
Nursing home residents are typically excluded in studies of out-of-hospital cardiac arrest (OHCA). Since nursing homes have on-site healthcare staff, cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) for OHCA would ideally be 100% before arrival of 9-1-1 emergency responders. However, little is known about healthcare provider bystander response and the degree of variability in initiating CPR and AED use in nursing homes.
Within the U.S. CARES registry, we identified 71,530 adults at nursing homes who had resuscitation initiated for OHCA between 2013-2021. We assessed rates of bystander CPR and AED application by nursing home healthcare staff. Using multivariable hierarchical logistic regression, we quantified variation in healthcare provider bystander CPR and AED application rates using the median odds ratio (OR), which estimates the difference in odds that 2 similar patients with OHCA would receive healthcare provider bystander CPR or have an AED applied at two randomly selected nursing homes.
Mean age was 74 ± 13 years and 53.5% were men. Overall, 58,814 (82.2%) patients received healthcare provider bystander CPR and 20,302 (28.4%) had an AED applied. Among 4014 nursing homes with ≥5 OHCAs ( = 42,399), the median OR for healthcare provider bystander CPR was 2.13 (95% CI: 2.05-2.22) and the median OR for healthcare provider bystander AED application was 4.54 (95% CI: 4.31-4.76), both suggesting several-fold variation in treatment across nursing homes.
In U.S. nursing homes, healthcare provider bystander CPR and AED application rates were not ideal, with large variation in both rates across sites.
院外心脏骤停（OHCA）的研究通常将养老院居民排除在外。由于养老院配备有现场医护人员，对于院外心脏骤停患者，理想情况下在911急救人员到达之前，心肺复苏（CPR）和自动体外除颤器（AED）的使用率应为100%。然而，对于医护人员旁观者的反应以及养老院中启动心肺复苏和使用自动体外除颤器的差异程度，我们知之甚少。
在美国CARES登记系统中，我们识别出2013年至2021年间在养老院接受复苏治疗的71530名院外心脏骤停成年患者。我们评估了养老院医护人员旁观者进行心肺复苏和使用自动体外除颤器的比例。使用多变量分层逻辑回归，我们采用中位数优势比（OR）对医护人员旁观者进行心肺复苏和使用自动体外除颤器的比例差异进行量化，该比值估计了两名类似的院外心脏骤停患者在两家随机选择的养老院接受医护人员旁观者心肺复苏或使用自动体外除颤器的优势差异。
平均年龄为74±13岁，男性占53.5%。总体而言，58814名（82.2%）患者接受了医护人员旁观者心肺复苏，20302名（28.4%）患者使用了自动体外除颤器。在4014家发生≥5例院外心脏骤停事件的养老院（n = 42399）中，医护人员旁观者心肺复苏的中位数优势比为2.13（95%置信区间：2.05 - 2.22），医护人员旁观者使用自动体外除颤器的中位数优势比为4.54（95%置信区间：4.31 - 4.76），两者均表明各养老院之间的治疗差异达数倍。
在美国养老院中，医护人员旁观者心肺复苏和自动体外除颤器的使用率并不理想，各场所的这两种比例均存在较大差异。
