Residents of nursing homes are often excluded from research on out-of-hospital cardiac arrest (OHCA). Given the presence of trained healthcare staff on site, one would expect near-universal initiation of cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use by these providers before emergency medical services arrive. However, data on bystander response by nursing home staff and the extent of facility-level differences in these practices remain limited. Using data from the U.S. Cardiac Arrest Registry to Enhance Survival (CARES) from 2013 to 2021, we identified 71,530 adults who experienced OHCA in nursing homes and had resuscitation attempted. We examined rates of CPR initiation and AED application performed by nursing home healthcare staff. Multivariable hierarchical logistic regression was used to measure facility-level variation in these interventions, expressed as the median odds ratio (MOR). The MOR indicates how much the odds of receiving staff-initiated CPR or AED application would differ for two identical patients at two randomly chosen nursing homes. The cohort had a mean age of 74 ± 13 years, with 53.5% male. Overall, 82.2% (58,814) received CPR from healthcare staff, and 28.4% (20,302) had an AED applied by staff. Among 4,014 nursing homes with at least 5 OHCAs (totaling 42,399 cases), the median OR was 2.13 (95 percent CI: 2.05–2.22) for staff CPR and 4.54 (95 percent CI: 4.31–4.76) for staff AED application, indicating substantial between-facility variation in both practices. Rates of healthcare provider-initiated CPR and AED use in U.S. nursing homes during OHCA fall short of optimal levels and show marked variation across facilities. These findings highlight opportunities to standardize and improve early resuscitation practices in this setting.
