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The rates in which nursing home staff perform CPR or use an automated external defibrillator on out-of-hospital cardiac arrest residents “were not ideal,” according to a new study. Researchers say findings draw attention to the need for better basic life support training for direct caregivers.
With healthcare staff readily available in nursing homes, the number of resuscitation attempts prior to the arrival of emergency responders should be 100%, researchers of the study featured in Resuscitation Plus said. But after assessing the rates of CPR and AED applications performed on out-of-hospital cardiac arrest nursing home residents over an eight year period, it was found that 82% of residents received CPR and just 28% received an AED application.
These numbers are especially worrisome since all out-of-hospital cardiac arrest residents were resuscitated when emergency responders arrived, researchers said. The gap in care appears to fall on nursing homes and their in-house protocols — or rather, lack of them.
“The wide variability in CPR rates raises concerns about the adequacy of basic cardiac life support training for healthcare staff working in nursing homes as BLS certification is required for staff,” study authors wrote. “Suboptimal rates of bystander CPR may be due to perceptions of futility in performing CPR for nursing home residents due to older age and greater comorbidity burden, but all the OHCAs in our study underwent resuscitative efforts with 9-1-1 emergency responders even if healthcare providers at the nursing home did not initiate CPR. Therefore, futility would not be expected to be a good reason as an emergency response was called.”
The study examined a total of 71,530 nursing home residents from 2013 to 2021 with a median age of 74 years old.
The light usage of AEDs — employed in just 22% of out-of-hospital cardiac arrest in nursing homes – could also be a result of inadequate training, along with the lack of on-site AEDs in nursing homes, the authors said.
Researchers cited another study by AED.com that reported that as low as 16% of US nursing homes have access to AEDs. Paired with the fact that federal regulations do not require that all federally supported nursing facilities provide on-site AEDs as part of their basic life support protocols, systemic change could be in store.
Improved resident outcomes
Researchers observed great efforts for AED implementation in some nursing homes.
Approximately 190 of the facilities examined reported a 90% to 100% AED application rate, showing that with proper training and preparation, widespread usage of AED is quite possible.
Improved outcomes in patients with cardiac arrests were found when there was early bystander CPR and an initial amenable rhythm, or if they were shocked with an AED before the arrival of emergency medical services, Rebecca D. Elon, professor of medicine at Johns Hopkins School of Medicine, wrote in a JAMDAreview.
She recommended that nursing home medical directors analyze and discuss the following for their facilities:
The facility’s current processes for determining and documenting code status
Processes and outcomes of its current BLS/CPR procedures
The community standard of care, and
The needs and wishes of the population being served by the facility
These steps can help to determine “… whether facility processes and procedures might need to evolve to improve outcomes,” Elon wrote.
“The efforts of individual medical directors and teams within individual facilities and companies have the potential to raise the bar of current practice for the benefit of those we serve,” she added.