Dissociation between resuscitation success and neurological recovery in nursing home cardiac arrest: A propensity-matched analysis.
The American journal of emergency medicine · 2026-07-28 · Registry study
Abstract
OBJECTIVES: To compare emergency department (ED) survival and neurological outcomes of out-of-hospital cardiac arrest (OHCA) at home versus in nursing homes. METHODS: Retrospective cohort study of the Korea Out-of-Hospital Cardiac Arrest Surveillance registry, 2019-2023. Among 93,195 medical-etiology OHCA cases, 63,568 occurred at home (n = 53,801) or in a nursing home (n = 9767). The primary outcome was ED survival, an early process endpoint since discharge survival is not uniformly recorded; the secondary outcome was documented favorable neurological outcome (CPC 1-2) at discharge. Multivariable logistic regression (complete cases, n = 24,914), propensity score matching, and multiple imputation adjusted for sex, age, prehospital ROSC, bystander CPR, AED use, and initial rhythm, with prespecified sensitivity analyses excluding ROSC. RESULTS: Crude ED survival was lower in nursing homes (11.2% vs 14.0%), but the adjusted association was small and specification-dependent: multivariable OR 1.13 (95% CI 1.00-1.28, p = 0.057), propensity-matched OR 1.21 (1.10-1.32, p < 0.001), and a similarly small positive association in whole-cohort imputation regardless of ROSC (OR 1.17-1.21); only the complete-case model with ROSC removed was null (OR 1.02, 0.91-1.14). Favorable neurological outcome was consistently lower in nursing homes (matched OR 0.45, 0.32-0.62): 4.5% of nursing home ED survivors had documented CPC 1-2, versus 21.8% of home ED survivors. CONCLUSIONS: Any ED survival difference for nursing home OHCA is small, specification-dependent, and vulnerable to unmeasured confounding, whereas neurological recovery is uniformly and robustly poor. These findings support early, structured goal-of-care discussions.