In:
Annals of the Academy of Medicine, Singapore, Academy of Medicine, Singapore, Vol. 49, No. 5 ( 2020-5-31), p. 285-293
Kurzfassung:
Introduction: 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. Materials and Methods: 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. Results: 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%, 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). Conclusion: 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.
Ann Acad Med Singapore 2020;49:285–93 Key words: Advance care directives, Do-not-resuscitate orders, Geriatrics, Out-of- hospital, Palliative care
Materialart:
Online-Ressource
ISSN:
0304-4602
DOI:
10.47102/annals-acadmedsg.
DOI:
10.47102/annals-acadmed.sg.2019244
Sprache:
Englisch
Verlag:
Academy of Medicine, Singapore
Publikationsdatum:
2020
ZDB Id:
2186627-2
