Should AEDs Become More Common in Nursing Homes?

Abstract

Automated external defibrillators, or AEDs, to manage cardiac arrest have become standard in many community settings. This was evident when first responders had to perform cardiopulmonary resuscitation (CPR) and use an AED on Buffalo Bills safety Damar Hamlin, who went into cardiac arrest on the football field in January. By contrast, AEDs are not standard in nursing homes. Nursing facilities that participate in Medicare and Medicaid must be able to provide basic life support (BLS), including CPR, in emergency situations, but they are not required to have AEDs on-site, and the extent of AED use is unknown. It may be time to re-evaluate CPR procedures among residents, says Rebecca Elon, MD, MPH, CMD, an associate professor at Johns Hopkins University School of Medicine. Previously, studies suggested that performing CPR on nursing home residents who experience cardiac arrest is futile, given that the likelihood of survival lessens as individuals age. One study, for instance, found that over a 13-year period, survival 30 days after CPR was performed was 6.7% among individuals aged 70 to 79, dropping to 4.4% among those aged 80 to 89 and 2.4% among those aged 90 and older (Resuscitation 2015;94:28–32). Studies also have found poorer outcomes in individuals who have comorbidities, even when an AED was used. However, Dr. Elon points out, many of those studies are more than a decade old. The most recent study dates to 2006, and none of the individuals in that study received CPR with an AED. Indeed, in four U.S. cities only 6.7% of nursing homes had AEDs, and 10% had manual defibrillators, as reported by another study that same year (J Am Med Direc Assoc 2006;7:413–415). When cardiac arrest occurs, the rate of survival diminishes by about 10% for every minute between the arrest and initiation of CPR, and the risk of prolonged brain damage increases due to cerebral hypoxia. However, recent studies have shown that outcomes have improved when someone witnesses the cardiac arrest and performs CPR using an AED. For example, a 2018 study in Denmark found that between 2001 and 2014, the overall survival in a limited cohort went from 1.7% to 7.7% when a bystander witnessed the cardiac arrest, performed CPR, and used an AED while awaiting emergency medical services (Resuscitation 2018;125:90–98). A German study of nursing facilities in 2020 found that among 2,900 CPR attempts over a seven-year period, only 118 patients (4.4%) were alive when they later left the hospital; 64 of those individuals (2.2% of the total) had a favorable cerebral performance (Dtsch Arztebl Int 2020;117:757–763). The researchers also found that in 64% of those cases the nursing staff did not attempt to resuscitate the resident but instead waited for the arrival of emergency personnel. Besides clinical outcomes, there are other considerations when deciding whether AEDs should be standard in nursing homes, such as staff time, especially considering shortages, and cost effectiveness. “Despite these various potential concerns, providing AEDs for nursing facility staff to utilize in the BLS/CPR protocols might prove to be an important quality-improvement intervention and risk-management tool for nursing facilities,” Dr. Elon writes. Source: Elon RD. Cardiac Resuscitation Procedures in US Nursing Facilities: Time to Reevaluate the Standard of Care? [published online: February 28, 2023]. J Am Med Dir Assoc. DOI: https://doi.org/10.1016/j.jamda.2023.01.029. Jeffrey S. Eisenberg, a freelance writer in the Philadelphia area, compiled this listing.