Abstract
Objective
To investigate the characteristics and outcomes of patients who experienced cardiac
arrest in nursing homes compared with those in private residences and determine prognostic
factors for survival.
Design
This was a retrospective study that analyzed data from an Utstein-style registry of
the Tokyo Fire Department.
Setting and Participants
We identified patients aged ≥65 years who experienced cardiac arrest in a nursing
home or private residence from the population-based registry of out-of-hospital cardiac
arrests in Tokyo, Japan, from 2014 to 2018.
Methods
Patients were grouped into the nursing home or the private residence groups according
to their cardiac arrest location. We compared the characteristics and outcomes between
the 2 groups and determined prognostic factors for survival in the nursing home group.
The primary outcome was 1-month survival after cardiac arrest.
Results
In total, 37,550 patient records (nursing home group = 6271; private residence group =
31,279) were analyzed. Patients in the nursing home group were significantly older
and more often had witnessed arrest, bystander cardiopulmonary resuscitation (CPR),
and shock delivery using an automated external defibrillator. The 1-month survival
rate was significantly higher in the nursing home group (2.6% vs 1.8%, P < .001). In the best scenario (daytime emergency call, witnessed cardiac arrest,
bystander CPR provided), the 1-month survival rate after cardiac arrest in the nursing
home group was 8.0% (95% confidence interval 6.4–9.9%), while none survived if they
had neither witness nor bystander CPR.
Conclusions and Implications
Survival outcome was significantly better in the nursing home group than in the private
residence group and was well stratified by 3 prognostic factors: emergency call timing,
witnessed status, and bystander CPR provision. Our results suggest that a decision
to withhold vigorous treatment solely based on nursing home residential status is
not justified, while termination of resuscitation may be determined by considering
significant prognostic factors.
Keywords
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Article info
Publication history
Published online: October 07, 2021
Footnotes
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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