• Andreas Günther, Jan Schildmann, Jürgen In der Schmitten, Sybille Schmid, Uta Weidlich-Wichmann, and Matthias Fischer.
• Fire Department, City of Braunschweig and Department of Anesthesiology, Braunschweig Hospitals gGmbH; Institute for the History and Ethics of Medicine, Medical Faculty, University of Halle-Wittenberg (Saale); Institute for Family Practice, Medical Faculty, University of Essen-Duisburg; Fire Department, City of Braunschweig; Faculty of Public Health Services, Ostfalia University of Applied Sciences, Campus Wolfsburg; Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Klinik am Eichert, Alb Fils Hospitals, Göppingen.
• Dtsch Arztebl Int. 2020 Nov 6; 117 (45): 757-763.

BackgroundData supporting decision-making regarding cardiopulmonary resuscitation (CPR) in German nursing homes is insufficient.MethodsA retrospective evaluation of pre-hospital CPR was carried out with data from the German Resuscitation Registry (Deutsches Reanimationsregister) for the years 2011-2018. Patients under age 65 were excluded, as were patients from districts in which long-term data was available for less than 60% of patients. Subgroups were analyzed based on age and certain prehospital situations; patients treated outside nursing homes were used for comparison.ResultsThe study group consisted of 2900 patients, whose mean age was 83.7 years (standard deviation, 7.5 years). 1766 (60.9%) were women and 1134 (39.1%) were men. 118 patients (4.0%) were discharged alive, including 64 (2.2%) with a cerebral performance category (CPC) of 1 or 2, 30 (1.0%) with an unknown CPC, and 24 (0.8%) with a CPC of 3 or 4. 902 patients (31.1%) died in the hospital, including five (0.2%) who died more than 30 days after resuscitation, 279 (9.6%) between 24 hours and 30 days, and 618 (21.3%) within 24 hours. 1880 patients (64.8%) died at the site of attempted resuscitation. In 1056 cases (36.4%), CPR was initiated before the arrival of the emergency medical services. In the "initially shockable" subgroup, 13 of 208 patients (6.3%) were discharged alive with a CPC of 1 or 2.ConclusionCPR can lead to a good neurological outcome in rare cases even when carried out in a nursing home. The large percentage of CPR attempts that were initiated only after a delay indicates that nursing home staff may often be uncertain how to proceed. Uncertainty among caregivers points to a potential for advance care planning.

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