Resuscitation of out-of-hospital cardiac arrests in residential aged care facilities in Melbourne, Australia

Introduction: CPR in patients in residential aged care facilities (RACF) deserves careful consideration. We examined the characteristics, management and outcomes of out-of-hospital cardiac arrest (OHCA) in RACF patients in Melbourne, Australia. Methods: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for all OHCAs occurring in RACFs in Melbourne. The characteristics and outcomes were compared to non-RACF patients in the VACAR. Results: Between 2000 and 2009 there were 30,006 OHCAs, 2350 (7.8 ) occurring in a RACF. A shockable rhythm was present in 179 (7.6 ) patients on arrival of paramedics of whom bystander CPR had been performed in 118 (66 ); 173 (97 ) received an EMS attempted resuscitation. ROSC was achieved in 71 (41 ) patients and 15 (8.7 ) patients survived to leave hospital. Non shockable rhythm was present in 2171 patients (92 ) of whom 804 (37 ) had an attempted resuscitation by paramedics. ROSC was achieved in 176 patients (22 ) and 10 patients (1.2 ) were discharged alive. Survival from OHCA occurring in a RACF was less than survival in those aged >70 years of age who suffered OHCA in their own homes (1.8 vs. 4.7 , p = 0.001). On multivariable analysis, witnessed OHCA (OR 3.0, 95 CI 2.4a??3.7) and the presence of bystander CPR (OR 4.6, 95 CI 3.7a??5.8) was associated with the paramedic decision to resuscitate. Conclusion: Resuscitation of patients in RACF is not futile. However, informed decisions concerning resuscitation status should be made by patients and their families on entry to a RACF. Where it is appropriate to perform resuscitation, outcomes may be improved by the provision of BLS training and possibly AED equipment to RACF staff.