CARDIOPULMONARY RESUSCITATION – COULD BE INAPPROPRIATE? THE EMERGENCY MEDICINE PROFESSIONALS PERCEPTION IN NORTH-EAST ROMANIA
Cardiopulmonary resuscitation (CPR) is started irrespective of comorbidity or cause of cardiac arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the personnel from Emergency Department (ED), the factors associated with perception and the relation to patient characteristics. Material and methods: A survey based on questionnaire was conducted in an ED of University Hospital, as a part of multicentric European study. Factors associated with perception of CPR and outcome were analyzed on statistic base. Results: Of the 54 participating clinicians, 57.4% perceived their last CPR attempt as appropriate, 38.9 % were uncertain about its appropriateness and 3.7% perceived inappropriateness. The prevalence of perception of inappropriate CPR was higher when one of this factor was present: non-shockable initial rhythm, inappropriate quality of CPR performed by witnesses before arrival, the advanced age of the patient, terminal neoplasia, low quality of life before cardiac arrest. The ED staff needs an early recognition of CPR futility, feedback, training and teamwork and performance evaluation after each CPR attempt. Conclusions: The perception of inappropriate CPR is present in a small percent inside ED staff. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.
2. Granfeldt A, Wissenberg M, Hansen SM, Lippert FK, Torp-Pedersen C, Christensen EF, et al. Loca-tion of cardiac arrest and impact of pre-arrest chronic disease and medication use on survival. Resus-citation 2017; 114: 113-120.
3. Tanaka H, Ong MEH, Siddiqui FJ, Ma MHM, Kaneko H, Lee KW, et al. Modifiable factors associated with survival after out-of-hospital cardiac arrest in the Pan-Asian resuscitation outcomes study. Ann Emerg Med 2018; 71: 608-615.
4. Chan PS, McNally B, Tang F, Kellermann A, CARES Surveillance Group. Recent trends in survival from out-of-hospital cardiac arrest in the United States. Circulation 2014; 130: 1876-1882.
5. Okubo M, Kiyohara K, Iwami T, Callaway CW, Kitamura T. Nationwide and regional trends in survival from out-of-hospital cardiac arrest in Japan: a 10-year cohort study from 2005 to 2014. Resuscitation 2017; 115: 120-128.
6. Gräsner J-T, Lefering R, Koster RW, Masterson S, Bottiger BW, Herlitz J, et al. EuReCa ONE-27 nations, ONE Europe, ONE registry: a prospective one-month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation 2016; 105: 188-195.
7. Daya MR, Schmicker RH, Zive DM, Rea TD, Nichol G, Buick JE, et al. Out-of-hospital cardiac arrest survival improving over time: results from the resuscitation outcomes consortium (ROC). Resuscitation 2015; 91: 108-115.
8. Marco CA, Bessman ES, Kelen GD. Ethical issues of cardiopulmonary resuscitation: comparison of emergency physician practices from 1995 to 2007. Acad Emerg Med 2009; 16: 270-273.
9. Marco CA, Schears RM. Prehospital resuscitation practices: a survey of prehospital providers. J Emerg Med 2003; 24: 101-106.
10. Brown SM, Azoulay E, Benoit D, Butler TP, Folcarelli P, Geller G, et al. The practice of respect in the intensive care unit. Am J Respir Crit Care Med 2018; 197: 1389-1395.
11. Meltzer LS, Huckabay LM. Critical care nurses’ perceptions of futile care and its effect on burnout. Am J Crit Care 2004; 13: 202-208.
12. Chan GK. Trajectories of approaching death in the emergency department: clinician narratives of patient transitions to the end of life. J Pain Symp Manage 2011; 42: 864-881.
13. Kon AA. Informed non-dissent: a better option than slow codes when families cannot bear to say, “let her die”. Am J Bioeth 2011; 11: 22-23.
14. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002; 136: 358-367.
15. Sulaiman CFC, Henn P, Smith S, O’Tuathaigh CMP. Burnout syndrome among nonconsultant hospital doctors in Ireland: relationship with self-reported patient care. Int J Qual Health Care 2017; 29: 679-684.
16. Jones PS, Lee JW, Phillips LR, Zhang XE, Jaceldo KB. An adaptation of Brislin’s translation model for cross-cultural research. Nurs Res 2001; 50: 300-304.
17. Piers RD, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, et al. Perceptions of ap-propriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA 2011; 306: 2694-2703.
18. Huybrechts SAM, Druwé P, Keulemans K, Vanhaute W, De Paepe P, Piers R, et al. Perception of inappropriate cardiopulmonary resuscitation: a multicenter cross-sectional survey in Flanders. Resus-citation 2015; 96(Suppl. 1): 31-32.
19. Goldstein H, Browne W, Rasbash J. Partitioning variation in multilevel models. Understanding Stat 2002; 1: 223-231.
20. Rajan S, Folke F, Hansen SM, Hansen CM, Kragholm K, Gerds TA, et al. Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology. Resuscitation 2017; 114: 157-163.
21. Grunau B, Puyat J, Wong H, Scheuermeyer FX, Reynolds JC, Kawano T, et al. Gains of continuing resuscitation in refractory out-of-hospital cardiac arrest: a model-based analysis to identify deaths due to intra-arrest prognostication. Prehosp Emerg Care 2018; 22: 198-207.
22. Bossaert LL, Perkins GD, Askitopoulou H, Raffay VI, Greif R, Haywood KL, et al. European resus-citation council guidelines for resuscitation 2015: section 11. The ethics of resuscitation and end-of-life decisions. Resuscitation 2015; 95: 302-311.
23. Brummell SP, Seymour J, Higginbottom G. Cardiopulmonary resuscitation decisions in the emergency department: an ethnography of tacit knowledge in practice. Soc Sci Med 2016; 156: 47-54.
24. Haywood K, Whitehead L, Nadkarni VM, Achana F, Beesems S, Bottiger BW, et al. COSCA (core outcome set for cardiac arrest) in adults: an advisory statement from the International liaison committee on. Resuscitation 2018; 127: 147-163.
25. Evans N, Bausewein C, Meñaca A, Andrew EVW, Higginson IJ, Harding R, et al. A critical review of advance directives in Germany: attitudes, use and healthcare professionals’ compliance. Patient Educ Couns 2012; 87: 277-288.
26. Rosoff PM, Schneiderman LJ. Irrational exuberance: cardiopulmonary resuscitation as fetish. Am J Bioeth 2017; 17: 26-34.
27. Wilson ME, Krupa A, Hinds RF, Litell JM, Swetz KM, Akhoundi A, et al. A video to improve patient and surrogate understanding of cardiopulmonary resuscitation choices in the ICU. Crit Care Med 2015; 43: 621-629.
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