Study Suggests Taking a Renewed Look at Standard Procedures for CPR and AEDs in Nursing Homes
FOR IMMEDIATE RELEASE: June 20, 2023
Contact: Ellen Mullally
Although using automated external defibrillators (AEDs) in out-of-hospital cardiac arrest (OHCA) response has become the standard of care in many community settings, AED adoption in U.S. nursing homes still varies. An article in the June issue of JAMDA reviewed data about cardiopulmonary resuscitation (CPR) outcomes in older adults and nursing facilities and proposes reevaluating standard procedures regarding the intervention in this care setting.
In Cardiac Resuscitation Procedures in the United States Nursing Facilities: Time to Reevaluate the Standard of Care, the authors determined that patients admitted for post-acute care in a skilled nursing facility are a separate cohort from the long-term care residents and typically expect to receive rehabilitation to improve clinically and return to the community. They said, “For both the long-term care residents and post-acute care patients who wish to have attempts at cardiac resuscitation performed in the event of a sudden cardiac arrest, advanced informed consent for CPR should be obtained.” They added that there is a need for updated studies of the outcomes of CPR with AEDs in nursing homes to help guide public policy.
The authors noted that while there are staffing shortages in nursing homes, giving staff the tools to implement their knowledge might not be burdensome, particularly since all clinical staff is required to undergo CPR training that includes the use of AEDs. They said, “The focus on CPR and the cost of AEDs are thought by some to take time and scarce resources away from improving the quality of care and quality of life for nursing facility residents in other realms of service.” Despite these concerns, they added, providing AEDs for nursing facility staff to utilize in the Basic Life Support (BLS)/CPR protocols might prove to be an important quality improvement intervention and risk management tool for nursing facilities.
While successful outcomes of BLS/CPR are less likely in nursing home residents with a high burden of comorbidities, the authors cautioned against labeling this intervention “futile” for this entire population. They said this “would deny proper care to those who might not fit in the general stereotype.” Determining the medical ineffectiveness of CPR, the authors noted, should be made on an individual basis. They concluded, “A possible exception to the construct might be a determination that CPR efforts in those with unwitnessed arrests already exhibiting lividity could be considered medically ineffective by definition, since they would meet criteria for irreversible death.”
This study was conducted by researchers at Johns Hopkins School of Medicine, Johns Hopkins University School of Medicine, Milwaukee, WI.
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.