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Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services : The REAPPROPRIATE international, multi-centre, cross sectional survey

Druwé, Patrick (författare)
Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
Monsieurs, Koenraad G. (författare)
Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium
Piers, Ruth (författare)
Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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Gagg, James (författare)
Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
Nakahara, Shinji (författare)
Teikyo University School of Medicine, Tokyo, Japan
Alpert, Evan Avraham (författare)
Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
van Schuppen, Hans (författare)
Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
Élö, Gabor (författare)
Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
Truhlar, Anatolij (författare)
Emergency Medical Services of the Hradec Kralove Region and University Hospital Hradec Kralove, Czech Republic
Huybrechts, Sofie A. (författare)
Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium
Mpotos, Nicolas (författare)
Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Joly, Luc-Marie (författare)
Department of Emergency Medicine, Rouen University Hospital, Rouen, France
Xanthos, Theodoros (författare)
European University, Nicosia, Cyprus, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
Roessler, Markus (författare)
Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany
Paal, Peter (författare)
Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
Cocchi, Michael N. (författare)
Harvard Medical School, Department of Emergency Medicine and Department of Anesthesia, Critical Care and Pain Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, United States
Björshol, Conrad (författare)
Department of Anesthesiology and Intensive Care, Stavanger University Hospital, The Regional Centre for Emergency Medical Research and Development (RAKOS), Department of Clinical Medicine, University of Bergen, Norway
Paulikova, Monika (författare)
Department of Anesthesiology and Intensive Care, East Slovak Institute of Oncology, Košice, Slovakia
Nurmi, Jouni (författare)
Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
Salmeron, Pascual Pinera (författare)
Hospital General Universitario Reina Sofia, Murcia, Spain
Owczuk, Radoslaw (författare)
Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland
Svavarsdottir, Hildigunnur (författare)
Akureyri Hospital and University of Akureyri, Akureyri, Iceland
Deasy, Conor (författare)
Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
Cimpoesu, Diana (författare)
University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania
Ioannides, Marios (författare)
Nicosia General Hospital, Nicosia, Cyprus
Aguilera Fuenzalida, Pablo (författare)
Pontificia Universidad Católica de Chile, Santiago, Chile
Kurland, Lisa, 1960- (författare)
Örebro universitet,Institutionen för medicinska vetenskaper,Department of Clinical Research and Education, Karolinska Institute, Stockholm, Sweden
Raffay, Violetta (författare)
Municipal Institute for Emergency Medicine, Novi Sad, Serbia
Pachys, Gal (författare)
Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
Gadeyne, Bram (författare)
Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
Steen, Johan (författare)
Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
Vansteelandt, Stijn (författare)
Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
De Paepe, Peter (författare)
Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
Benoit, Dominique D. (författare)
Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
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 (creator_code:org_t)
Elsevier, 2018
2018
Engelska.
Ingår i: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 132, s. 112-119
Relaterad länk:
https://helda.helsin...
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https://urn.kb.se/re...
https://doi.org/10.1...
http://kipublication...
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  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • Introduction: Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome.Methods: A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models.Results: Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician's characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P < .0001), a non-witnessed arrest (2.68 [1.89-3.79]; P < .0001), in older patients (2.94 [2.18-3.96]; P < .0001, for patients > 79 years) and in case of a "poor" first physical impression of the patient (3.45 [2.36-5.05]; P < .0001). In accordance, non-shockable and non-witnessed arrests were both associated with lower survival to hospital discharge (0.33 [0.26 - 0.41]; P < 0.0001 and 0.25 [0.15 - 0.41]; P < 0.0001, respectively), as were older patient age (0.25 [0.14 - 0.44]; P < 0.0001 for patients > 79 years) and a "poor" first physical impression (0.26 [0.19-0.35]; P < 0.0001).Conclusions: The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)

Nyckelord

Cardiac arrest
Out-of-hospital
Cardiopulmonary resuscitation
Inappropriate care
Perception

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