CPR - Could be Inappropriate? The Emergency Medicine Professionals' Perception

Introduction Cardiopulmonary resuscitation (CPR) is started irrespectively of comorbidity or the cause of the cardiac arrest. We aimed to determine the prevalence of the perception of inappropriate CPR of the Emergency Department (ED) personnel, the factors associated with this perception and the relation to the patient characteristics. Methods A survey based on questionnaire was conducted in an ED of a University Hospital, as a part of a multicentric European study. Factors associated with perception of CPR and outcomes were analysed on statistic base. Results Out of the 54 participating clinicians, 57,4% perceived their latest CPR attempt as appropriate, 38,9% were uncertain about its appropriateness and 3,7% perceived it as inappropriate. The prevalence of perception of inappropriate CPR was higher when one of these factors was present: non-shockable initial rhythm, inappropriate quality of CPR performed by witnesses before arrival, the advanced age of the patient, terminal neoplasia, low quality of life before cardiac arrest. The ED staff needs an early recognition of CPR futility, feedback, training and teamwork and performance evaluation after each CPR attempt. Conclusions The perception of inappropriate CPR is present in a small percent inside ED staff. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.