Nursing Home Residents Have Better Survival Outcomes After Cardiac Arrest Than Adults in the Community
FOR IMMEDIATE RELEASE
August 16, 2022
Contact: Ellen Mullally
Survival outcomes after cardiac arrest were significantly better for nursing home residents versus community-dwelling older adults, according to a study in the August issue of JAMDA.
In Nursing Home Versus Community Resuscitation After Cardiac Arrest: Comparative Outcomes and Risk Factors, the authors studied patient records for nursing home residents and older adults in private residences who experienced cardiac arrest (defined as the cessation of cardiac mechanical activity as confirmed by the absence of circulation signs). The nursing home residents were significantly older and more often had witnesses to the event, bystander cardiopulmonary resuscitation (CPR), and shock delivery using an automated external defibrillator. Nearly all (96.6%) of the witnesses in the nursing home were health-care providers; in the private residence group, most witnesses (89.1%) were family members.
The one-month survival rate was significantly higher in the nursing home group (2.6% versus 1.8%). The study indicated that several factors were associated with the higher survival rate in nursing homes such as professional witnesses to the cardiac event, bystander CPR, initial shockable cardiac rhythm, non-cardiac etiology, and shorter call-to-response time.
Because nursing home residents have a higher age and comorbidity burden, the authors said, “Ethical dilemmas may arise regarding whether resuscitation attempts are medically nonbeneficial and therefore should not be initiated in cases of cardiac arrest in this location.” Furthermore, they noted, “The definition of ‘futility’ may depend on the acceptability of the patient, family members, and healthcare providers involved in each case.”
The authors concluded, “Our results suggest that the decision to withhold vigorous resuscitation solely based on nursing home residential status is not justified, while the termination of resuscitation may be considered after taking into account witnessed status and bystander CPR provision. There remains a need for further discussion regarding futility.”
This article was conducted by researchers at the Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Kotobashi, Sumida-ku, Tokyo, Japan; and the Tokyo Fire Department, Tokyo, Japan.
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JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.