The decision to perform cardiopulmonary resuscitation on older nursing home residents can be fraught with uncertainty, but a new study from Japan suggests that the risk is worth the reward.
Using Tokyo Fire Department registry data, investigators compared one-month outcomes after cardiac arrest in more than 37,000 nursing home residents and adults living in the community in private residences. Study subjects were aged 65 years and older. None of the events occurred in a hospital.
The one-month survival rate was significantly higher in the nursing home group, the study’s authors reported. Although the nursing home residents were much older overall, they more often experienced the best-case scenarios for optimal outcomes. This included witnesses to the cardiac arrest, bystander CPR, and shock delivery using an automated external defibrillator.
In these best-case scenarios, nursing home residents had an 8% one-month survival rate, while none survived if there was no witness or bystander CPR. Their likelihood of survival could be predicted by three factors, the researchers said: emergency call timing, witnessed status and bystander CPR provision.
“Our results suggest that a decision to withhold vigorous treatment solely based on nursing home residential status is not justified,” they wrote. The decision to stop resuscitation could be determined in part by these significant predictive factors, they concluded.
The study was published in JAMDA.