Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional surveyTeikyo University School of Medicine, Tokyo, Japan.
Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel.
Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
Emergency Medical Services of the Hradec Kralove Region and University Hospital Hradec Kralove, Czech Republic.
Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium.
Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium..
Department of Emergency Medicine, Rouen University Hospital, Rouen, France.
European University, Nicosia, Cyprus, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany.
Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria.
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.
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.
Department of Anesthesiology and Intensive Care, East Slovak Institute of Oncology, Košice, Slovakia.
Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
Hospital General Universitario Reina Sofia, Murcia, Spain.
Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland.
Akureyri Hospital and University of Akureyri, Akureyri, Iceland.
Department of Emergency Medicine, Cork University Hospital, Cork, Ireland.
University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania.
Nicosia General Hospital, Nicosia, Cyprus.
Pontificia Universidad Católica de Chile, Santiago, Chile.
Municipal Institute for Emergency Medicine, Novi Sad, Serbia.
Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel.
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.
Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium.
Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
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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
2018-10-222018-10-222024-01-16Bibliographically approved