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

被引：28

作者：

Druwe, Patrick ^{[1
]}

Monsieurs, Koenraad G. ^{[2
]}

Piers, Ruth ^{[3
]}

Gagg, James ^{[4
]}

Nakahara, Shinji ^{[5
]}

Alpert, Evan Avraham ^{[6
]}

van Schuppen, Hans ^{[7
]}

Elo, Gabor ^{[8
]}

Truhlar, Anatolij ^{[9
,10
]}

Huybrechts, Sofie A. ^{[2
]}

Mpotos, Nicolas ^{[11
]}

Joly, Luc-Marie ^{[12
]}

Xanthos, Theodoros ^{[13
,14
]}

Roessler, Markus ^{[15
]}

Paal, Peter ^{[16
]}

Cocchi, Michael N. ^{[17
,18
]}

Bjorshol, Conrad ^{[19
]}

Paulikova, Monika ^{[20
]}

Nurmi, Jouni ^{[21
]}

Salmeron, Pascual Pinera ^{[22
]}

Owczuk, Radoslaw ^{[23
]}

Svavarsdottir, Hildigunnur ^{[24
,25
]}

Deasy, Conor ^{[26
]}

Cimpoesu, Diana ^{[27
,28
]}

Ioannides, Marios ^{[29
]}

Aguilera Fuenzalida, Pablo ^{[30
]}

Kurland, Lisa ^{[31
,32
]}

Raffay, Violetta ^{[33
]}

Pachys, Gal ^{[6
]}

Gadeyne, Bram ^{[1
]}

Steen, Johan ^{[1
]}

Vansteelandt, Stijn ^{[34
,35
]}

De Paepe, Peter ^{[36
]}

Benoit, Dominique D. ^{[1
]}

机构：

[1] Ghent Univ Hosp, Dept Intens Care Med, Corneel Heymanslaan 10, Ghent, Belgium

[2] Antwerp Univ Hosp, Dept Emergency Med, Antwerp, Belgium

[3] Ghent Univ Hosp, Dept Geriatr Med, Ghent, Belgium

[4] Taunton & Somerset NHS Fdn Trust, Dept Emergency Med, Musgrove Pk Hosp, Taunton, Somerset, England

[5] Teikyo Univ, Sch Med, Tokyo, Japan

[6] Shaare Zedek Med Ctr, Emergency Dept, Jerusalem, Israel

[7] Univ Amsterdam, Dept Anesthesiol, Amsterdam UMC, Amsterdam, Netherlands

[8] Semmelweis Univ, Dept Anaesthesiol & Intens Therapy, Budapest, Hungary

[9] Emergency Med Serv Hradec Kralove Reg, Hradec Kralove, Czech Republic

[10] Univ Hosp Hradec Kralove, Hradec Kralove, Czech Republic

[11] Univ Ghent, Fac Med & Hlth Sci, Ghent, Belgium

[12] Rouen Univ Hosp, Dept Emergency Med, Rouen, France

[13] European Univ, Nicosia, Cyprus

[14] Hellenic Soc Cardiopulm Resuscitat, Athens, Greece

[15] Univ Med Ctr Gottingen, Dept Anaesthesiol, Gottingen, Germany

[16] Univ Hosp Innsbruck, Dept Anesthesiol & Crit Care Med, Innsbruck, Austria

[17] Harvard Med Sch, Dept Emergency Med, Boston, MA USA

[18] Harvard Med Sch, Dept Anesthesia Crit Care & Pain Med, Div Crit Care, Beth Israel Deaconess Med Ctr, Boston, MA USA

[19] Univ Bergen, Reg Ctr Emergency Med Res & Dev RAKOS, Dept Anesthesiol & Intens Care, Dept Clin Med,Stavanger Univ Hosp, Bergen, Norway

[20] East Slovak Inst Oncol, Dept Anesthesiol & Intens Care, Kosice, Slovakia

[21] Helsinki Univ Hosp, Emergency Med & Serv, Helsinki, Finland

[22] Hosp Gen Univ Reina Sofia, Murcia, Spain

[23] Med Univ Gdansk, Dept Anaesthesiol & Intens Therapy, Gdansk, Poland

[24] Akureyri Hosp, Akureyri, Iceland

[25] Univ Akureyri, Akureyri, Iceland

[26] Cork Univ Hosp, Dept Emergency Med, Cork, Ireland

[27] Univ Med & Pharm GrT Popa, Iasi, Romania

[28] Emergency Cty Hosp Sf Spiridon, Iasi, Romania

[29] Nicosia Gen Hosp, Nicosia, Cyprus

[30] Pontificia Univ Catolica Chile, Santiago, Chile

[31] Orebro Univ, Dept Med Sci, Stockholm, Sweden

[32] Karolinska Inst, Dept Clin Res & Educ, Stockholm, Sweden

[33] Municipal Inst Emergency Med, Novi Sad, Serbia

[34] Univ Ghent, Fac Sci, Dept Appl Math Comp Sci & Stat, Ghent, Belgium

[35] London Sch Hyg & Trop Med, Dept Med Stat, London, England

[36] Ghent Univ Hosp, Dept Emergency Med, Ghent, Belgium

来源：

RESUSCITATION | 2018年 / 132卷

关键词：

Cardiac arrest; Out-of-hospital; Cardiopulmonary resuscitation; Inappropriate care; Perception; HOSPITAL CARDIAC-ARREST; SURVIVAL; PATIENT; CARE; OUTCOMES; BURNOUT; TRENDS; NURSES; MODEL; END;

D O I：

10.1016/j.resuscitation.2018.09.006

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页码：112 / 119

页数：8

共 30 条

[1] Improved Survival After Out-of-Hospital Cardiac Arrest and Use of Automated External Defibrillators
Blom, Marieke T.
Beesems, Stefanie G.
Homma, Petronella C. M.
Zijlstra, Jolande A.
Hulleman, Michiel
van Hoeijen, Daniel A.
Bardai, Abdennasser
Tijssen, Jan G. P.
Tan, Hanno L.
Koster, Rudolph W.
[J]. CIRCULATION, 2014, 130 (21) : 1868 - +
[2] European Resuscitation Council Guidelines for Resuscitation 2015 Section 11. The ethics of resuscitation and end-of-life decisions
Bossaert, Leo L.
Perkins, Gavin D.
Askitopoulou, Helen
Raffay, Violetta I.
Greif, Robert
Haywood, Kirstie L.
Mentzelopoulos, Spyros D.
Nolan, Jerry P.
Van de Voorde, Patrick
Xanthos, Theodoros T.
[J]. RESUSCITATION, 2015, 95 : 302 - 311
[3] The Practice of Respect in the ICU
Brown, Samuel M.
Azoulay, Elie
Benoit, Dominique
Butler, Terri Payne
Folcarelli, Patricia
Geller, Gail
Rozenblum, Ronen
Sands, Ken
Sokol-Hessner, Lauge
Talmor, Daniel
Turner, Kathleen
Howell, Michael D.
[J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2018, 197 (11) : 1389 - 1395
[4] Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice
Brummell, Stephen P.
Seymour, Jane
Higginbottom, Gina
[J]. SOCIAL SCIENCE & MEDICINE, 2016, 156 : 47 - 54
[5] Trajectories of Approaching Death in the Emergency Department: Clinician Narratives of Patient Transitions to the End of Life
Chan, Garrett K.
[J]. JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 2011, 42 (06) : 864 - 881
[6] Recent Trends in Survival From Out-of-Hospital Cardiac Arrest in the United States
Chan, Paul S.
McNally, Bryan
Tang, Fengming
Kellermann, Arthur
[J]. CIRCULATION, 2014, 130 (21) : 1876 - +
[7] CORDAY E, 1965, CAN MED ASSOC J, V93, P949
[8] Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC)
Daya, Mohamud R.
Schmicker, Robert H.
Zive, Dana M.
Rea, Thomas D.
Nichol, Graham
Buick, Jason E.
Brooks, Steven
Christenson, Jim
MacPhee, Renee
Craig, Alan
Rittenberger, Jon C.
Davis, Daniel P.
May, Susanne
Wigginton, Jane
Wang, Henry
[J]. RESUSCITATION, 2015, 91 : 108 - 115
[9] A critical review of advance directives in Germany: Attitudes, use and healthcare professionals' compliance
Evans, Natalie
Bausewein, Claudia
Menaca, Arantza
Andrew, Erin V. W.
Higginson, Irene J.
Harding, Richard
Pool, Robert
Gysels, Marjolein
[J]. PATIENT EDUCATION AND COUNSELING, 2012, 87 (03) : 277 - 288
[10] Goldstein H., 2002, Understanding Statistics, V1, P223, DOI 10.1207/S15328031US0104_02

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