Outcomes of cardiac arrest in the nursing home: destiny or futility? [see comment].
OBJECTIVE
To compare EMS system characteristics and outcomes between nursing home (NH) patients and out-of-hospital cardiac arrest (OHCA) patients whose arrests occurred in a residence (home).


METHODS
Prospective cohort study reviewing OHCA from July 1989 to December 1993. Variables were age, witnessed arrest, response intervals, automated external defibrillator (AED) use, and arrest rhythms. Outcomes were hospital admission and discharge. Pearson chi-square was used for analysis.


METHODS
Suburban EMS system.


METHODS
Patients > or = 19 years old with arrest of presumed cardiac cause, with locations at home or at a NH.


RESULTS
2,348 total arrests were complete for analysis, 182 at a NH and 2,166 at home. BLS and ALS response intervals were shorter for the NH patients. The NH patients were more likely to receive CPR on collapse, were older (73.1 vs 67.5 years, p < 0.001), were less likely to have had an AED used (9.9% vs 30.0%, p < 0.001), and were more likely to have an arrest bradyasystolic rhythm (74.7% vs 51.5%, p < 0.001). They were less likely to survive to hospital admission (10.4% vs 18.5%, p < 0.006) and discharge (0.0% vs 5.6%, p < 0.001).


CONCLUSIONS
During this four-and-a-half-year study period, no NH patient survived, even though % CPR was increased. Arrest rhythm is an important factor in this finding. EMS initial care for ventricular tachycardia/fibrillation NH patients, with less application of AEDs, was identified. This different response may adversely contribute to dismal NH outcome.
Department of Emergency Medicine, Lapeer Regional Medical Hospital, MI, USA.
R
R
Benkendorf
R A
RA
Swor
R
R
Jackson
E J
EJ
Rivera-Rivera
A
A
Demrick
D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012189:Retrospective Studies; D019036:Suburban Health Services; D016019:Survival Analysis; D016896:Treatment Outcome