Do Medical Tubes Affect Outcomes of Older Patients with In-Hospital Cardiac Arrest? Results of a National Health Insurance Database Analysis

Abstract

Abstract Background With a rapidly aging population, older patients had higher risk of functional deficits with medical tubes. This study investigated whether the placement of medical tubes affect outcomes of older patients with in-hospital cardiac arrest. Methods Based on data from Taiwan’s National Health Insurance Research Database from January 1, 2000, to December 31, 2012, a retrospective longitudinal cohort study was conducted to enroll patients aged ≥ 65 years who underwent a first CPR event. All enrolled cases were followed for at least one year before 2013 or until death within one year. Demographic factors, comorbidities, main admission diagnoses, CPR process, and medical tubes dependency were assessed. Logistic regression analysis was used to estimate factors of those who survived to discharge and 1-year survivors. Results Among 6034 eligible patients, 669 (11.09%) survived to discharge, 206 of whom survived for more than 1 year. In the survival-to-discharge model, either univariate or multivariate analysis, patients with age ≥ 85 years, with a main diagnosis of infection or malignancy at admission, a nonventricular fatal arrhythmia or longer duration of cardiac massage, and requiring a nasogastric tube were less likely to be successfully resuscitated, with prolonged cardiac massage (> 11 min) being the strongest factor (OR: 3.922, 95% CI: 2.270–6.766, p = 0.003). Less than 30% of cases were survival to discharged without long-term tube dependency. The following factors, older age, male sex, high Charlson–Deyo Comorbidity Index (CCI) scores, and long-term tube dependency after CPR, decreased 1-year survival among surviving older adults with noncritical discharge. Among them, the long-term need for three medical tubes was the significantly associated with lower rates of 1-year survival. (OR: 6.818, 95% CI: 4.068–11.427, P < 0.001) Conclusions and Implications Different medical tubes have inconsistent effects on the survival to discharge of older patients with in-hospital cardiac arrest. Prolonged cardiac massage was the most important risk of non-survival to discharge among older patients with in-hospital cardiac arrest, and long-term multiple-tube dependency, which implies functional deficits, was highly prevalent after CPR and the strongest factor affecting 1-year survival.