title: Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile.
abstract: BACKGROUND
  Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years, and new data are therefore needed to avoid unsubstantiated statements when debating futility of resuscitation attempts following OHCA in nursing home (NH)-residents. We aimed to investigate the outcome and prognosis after OHCA in NH.
  
  
  METHODS
  Consecutive Emergency Medical Service (EMS) attended OHCA-patients in Copenhagen during 2007-2011 were included. Utstein-criteria for pre-hospital data and review of individual patient charts for in-hospital post-resuscitation care were collected.
  
  
  RESULTS
  A total of 2541 consecutive OHCA-patients were recorded, 245 (10%) of who were current NH-residents. NH-patients were older, more frequently female, had more witnessed arrests, fewer shockable primary rhythm and assumed cardiac aetiology, but shorter time to the return of spontaneous circulation (ROSC) compared to OHCA in non-nursing homes (non-NH). Overall 30-day survival rate was 9% in NH and 18% in non-NH, p<0.001. Of the 245 NH-arrests 79 (32%) patients were admitted to hospital compared to 937 (41%) from non-NH (p<0.001). Thirty-day survival rate in patients admitted to hospital were 27% for NH- and 42% for non-NH-patients, p<0.001. OHCA in NH was, however, not associated with a significantly worse prognosis (HR=0.88 (0.64-1.21), p=0.4) after adjustment for known prognostic factors including co-morbidity.
  
  
  CONCLUSIONS
  Nursing home residents resuscitated from OHCA and admitted to hospital have similar survival rates as non-NH-patients when adjusting for known prognostic factors and pre-existing co-morbidity. A policy of not attempting resuscitation in nursing homes at all may therefore not be justified.
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark. Electronic address: helle.soholm@gmail.com.
authors.forename: Helle
authors.initials: H
authors.lastname: Søholm
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: John
authors.initials: J
authors.lastname: Bro-Jeppesen
authors.affiliation: Emergency Medical Services, Copenhagen, The Capital Region of Denmark, Denmark.
authors.forename: Freddy K
authors.initials: FK
authors.lastname: Lippert
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Cardiothoracic Anaesthesia 4142, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Wanscher
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaergaard
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012151:Resuscitation; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Cardiac arrest; Nursing home; Out-of-hospital cardiac arrest; Prognosis; Survival