Patrick Druwé1, Koenraad G Monsieurs2, Ruth Piers3, James Gagg4, Shinji Nakahara5, Evan Avraham Alpert6, Hans van Schuppen7, Gábor Élő8, Anatolij Truhlář9, Sofie A Huybrechts2, Nicolas Mpotos10, Luc-Marie Joly11, Theodoros Xanthos12, Markus Roessler13, Peter Paal14, Michael N Cocchi15, Conrad BjØrshol16, Monika Pauliková17, Jouni Nurmi18, Pascual Piñera Salmeron19, Radoslaw Owczuk20, Hildigunnur Svavarsdóttir21, Conor Deasy22, Diana Cimpoesu23, Marios Ioannides24, Pablo Aguilera Fuenzalida25, Lisa Kurland26, Violetta Raffay27, Gal Pachys6, Bram Gadeyne28, Johan Steen28, Stijn Vansteelandt29, Peter De Paepe30, Dominique D Benoit28. 1. Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: patrick.druwe@ugent.be. 2. Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium. 3. Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium. 4. Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom. 5. Teikyo University School of Medicine, Tokyo, Japan. 6. Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel. 7. Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 8. Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary. 9. Emergency Medical Services of the Hradec Kralove Region and University Hospital Hradec Kralove, Czech Republic. 10. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. 11. Department of Emergency Medicine, Rouen University Hospital, Rouen, France. 12. European University, Nicosia, Cyprus, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece. 13. Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany. 14. Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria. 15. 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, USA. 16. 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. 17. Department of Anesthesiology and Intensive Care, East Slovak Institute of Oncology, Košice, Slovakia. 18. Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland. 19. Hospital General Universitario Reina Sofia, Murcia, Spain. 20. Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland. 21. Akureyri Hospital and University of Akureyri, Akureyri, Iceland. 22. Department of Emergency Medicine, Cork University Hospital, Cork, Republic of Ireland. 23. University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania. 24. Nicosia General Hospital, Nicosia, Cyprus. 25. Pontificia Universidad Católica de Chile, Santiago, Chile. 26. Department of Medical Sciences, Örebro University and Department of Clinical Research and Education, Karolinska Institute, Stockholm, Sweden. 27. Municipal Institute for Emergency Medicine, Novi Sad, Serbia. 28. Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. 29. 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. 30. Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium.
Abstract
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.
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.
Authors: Paul Zajic; Philipp Zoidl; Marlene Deininger; Stefan Heschl; Tobias Fellinger; Martin Posch; Philipp Metnitz; Gerhard Prause Journal: Sci Rep Date: 2021-03-04 Impact factor: 4.379
Authors: Spyros D Mentzelopoulos; Keith Couper; Patrick Van de Voorde; Patrick Druwé; Marieke Blom; Gavin D Perkins; Ileana Lulic; Jana Djakow; Violetta Raffay; Gisela Lilja; Leo Bossaert Journal: Notf Rett Med Date: 2021-06-02 Impact factor: 0.826
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