CPR in nursing homes: The debate turns upside down under
Intrepid Daily Show correspondent John Oliver recently headed Down Under. His assignment: Find out how Australia's strict gun control measures have played out since being passed in the mid-1990s.
You may or may not agree with Oliver's report, which suggested (in usual absurdist Daily Show-fashion) that the United States should enact gun laws similar to Australia's. But it occurred to me that Oliver might be able to repeat this trip in the future, only instead of reporting on Aussie gun control, his subject might be the country's move away from CPR in nursing homes.
Fewer than 1 in 5 managers of Australian aged care facilities favors giving cardiopulmonary resuscitation to residents who have heart attacks, according to recent research from the Respecting Patient Choices Program (RPCP) at Austin Hospital outside Melbourne.
Despite finding such low staff support for CPR among the more than 400 people surveyed, 4 out 5 facilities involved in the study require workers to administer CPR if they witness a resident in cardiac arrest.
''This revealed a significant difference between what the staff thought would be appropriate for their residents and what they were expected to do,'' wrote researcher Bill Silvester, M.D.
The study was prompted by the high number of nursing home residents who end up in intensive care after receiving CPR. The central question — “Is it really worth using CPR to save the lives of aged nursing home residents, only to leave them suffering, with sometimes severely reduced brain function?” — has been the cause of much recent soul-searching in the United States as well. In March, a 911 recording captured an employee at a Brookdale Senior Living facility refusing to give CPR to a resident who later died.
That event caused an outcry against the worker and the facility's CPR policy. But some prominent medical experts — and a McKnight's senior editor — weighed in to defend the decision to withhold CPR, or at least think twice before giving it. David Newman, M.D., director of clinical research in the department of medicine at New York City's Mount Sinai School of Medicine, told the Washington Post we should think of CPR in terms of surgery.
“We should think of CPR as an invasive, burdensome, punishing procedure,” he said. “We would never say that a bed-bound, chronically ill, debilitated person should immediately go into surgery if they have an emergency.”
The vast majority of Australian nursing home managers seem to agree with Newman, and their responses to the RPCP survey have led to calls for new CPR guidelines in the country's senior care facilities. And the RPCP findings came out at the same time that other research challenged the American Heart Association's guidelines on the best ways to administer CPR.
As the response to the Brookdale incident showed, the prospect of withholding potentially life-saving treatment from a person in acute distress understandably upsets many people. A campaign to limit CPR in nursing homes could rouse passionate opposition. If Australia is an early mover on reforms, that could provide valuable evidence to weigh. I hope John Oliver is on the job, ready to keep us apprised of the latest developments.