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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
Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium.ORCID iD: 0000-0002-5068-4848
Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.
Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom.
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 132, p. 112-119Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 132, p. 112-119
Keywords [en]
Cardiac arrest, Out-of-hospital, Cardiopulmonary resuscitation, Inappropriate care, Perception
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:oru:diva-69712DOI: 10.1016/j.resuscitation.2018.09.006ISI: 000446854900023PubMedID: 30218746Scopus ID: 2-s2.0-85053466864OAI: oai:DiVA.org:oru-69712DiVA, id: diva2:1257772
Note

Funding Agencies:

Fund Marie-Therese De Lava, King Baudouin Foundation, Belgium  

Research Foundation Flanders (FWO)  1800513N 

Available from: 2018-10-22 Created: 2018-10-22 Last updated: 2018-10-22Bibliographically approved

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Kurland, Lisa

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