Healthcare provider bystander CPR and AED rates for cardiac arrest in U.S. nursing homes

Nursing home residents are typically excluded in studies of out-of-hospital cardiac arrest (OHCA). Since nursing homes have on-site healthcare staff, cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) for OHCA would ideally be 100% before arrival of 9-1-1 emergency responders. However, little is known about healthcare provider bystander response and the degree of variability in initiating CPR and AED use in nursing homes.

Within the U.S. CARES registry, we identified 71,530 adults at nursing homes who had resuscitation initiated for OHCA between 2013-2021. We assessed rates of bystander CPR and AED application by nursing home healthcare staff. Using multivariable hierarchical logistic regression, we quantified variation in healthcare provider bystander CPR and AED application rates using the median odds ratio (OR), which estimates the difference in odds that 2 similar patients with OHCA would receive healthcare provider bystander CPR or have an AED applied at two randomly selected nursing homes.

Mean age was 74 ± 13 years and 53.5% were men. Overall, 58,814 (82.2%) patients received healthcare provider bystander CPR and 20,302 (28.4%) had an AED applied. Among 4014 nursing homes with ≥5 OHCAs (n = 42,399), the median OR for healthcare provider bystander CPR was 2.13 (95% CI: 2.05-2.22) and the median OR for healthcare provider bystander AED application was 4.54 (95% CI: 4.31-4.76), both suggesting several-fold variation in treatment across nursing homes.

In U.S. nursing homes, healthcare provider bystander CPR and AED application rates were not ideal, with large variation in both rates across sites.