CPR in the Nursing Home Setting
Cardiopulmonary resuscitation (CPR) and defibrillation are associated with increased survival in patients suffering from cardiac arrest. As a result, the American Heart Association has worked with other organizations to promote the “Chain of Survival” to maximize the quality of care provided to patients suffering from cardiac arrest in hopes of maximizing the survival rate.
Some studies have shown that few nursing home residents survive cardiac arrest. Reasons for this poor survival have been related to unwitnessed arrest, poor staff response, or lack of facility willingness to honor “full code” requests.
What are the statistics related to CPR in the nursing home setting?
Nursing home residents suffering cardiac arrest often do not receive CPR or defibrillation while awaiting EMS arrival. Studies have shown that over 1/3 of all cardiac arrests are witnessed by staff in nursing homes, increasing the likelihood of successful resuscitation, yet 33% of residents who are a “full code” do not receive CPR prior to EMS arrival. This is a significant problem because studies have shown that 20% of residents who do receive CPR are resuscitated before EMS even arrives. The survival rate in those who do receive CPR has not been shown to be significantly different from those who receive CPR in the community setting. The impact of not providing CPR and defibrillation is significant due to younger patients entering the nursing home setting for long-term therapy and for short-term rehabilitation.
Do most nursing homes have automatic external defibrillators (AEDs) like I see in airports and other public places?
It is important to note that nursing homes rarely have an AED on site, even though current American Heart Association CPR training for healthcare providers requires education as to their use, and studies have shown their benefit in the resuscitation process prior to EMS arrival.
Are nursing homes obligated to perform CPR?
Yes, performing CPR is indicated and is an expectation. Sadly, not all nursing homes are agreeable to providing CPR and emergency care, even if you and your loved one have requested for it to be done in the case of emergency. As mentioned earlier, studies have supported the fact that nursing home residents suffering cardiac arrest often did not receive CPR or defibrillation while awaiting EMS arrival. In Kane and Burn’s (1997) study of 346 nursing homes, 4% indicated that they would not provide CPR or call EMS, 23% indicated that they would not perform CPR but would call EMS if requested, 15% would provide CPR if requested but not in the absence of an advanced directive, and 57% indicated that they would provide CPR in the absence of an advanced directive.
Questions to ask the nursing home related to CPR:
- How often does your staff get training in CPR (it should be at least every two years)?
- Who on your staff is trained in CPR (it should at least be nurses and ideally nursing assistants as well)?
- What is your policy for performing CPR when you find my loved one not breathing and with no pulse, and my loved one and I have requested CPR?
- How long does it take EMS to get here when you call 911?
- Do you have personal pocket masks for staff to wear when performing CPR? Where are these located?
- Do you have an AED? Does staff know how to use it?
Becker LJ, Yeargin K, Rea TD, et al.. Resuscitation of residents with do not resuscitate orders in long-term care facilities. Prehosp Disaster Med. 2003;7:303–306.
Duthie E, Mark D, Tresch D, et al.. Utilization of cardiopulmonary resuscitation in nursing homes in one community (Rates and nursing home characteristics). J Am Geriatr Soc. 1993;41:384–388. MEDLINE
Ghusn HF, Teasdale TA, Pepe PE, et al.. Older nursing home residents have a cardiac arrest survival rate similar to that of older persons living in the community. J Am Geriatr Soc. 1995;43:520–527. MEDLINE
Kane RS, Burns EA. Cardiopulmonary resuscitation polices in long-term care facilities. J Am Geriatr Soc. 1997;45:154–157. MEDLINE