Age as a determinant of cardiopulmonary resuscitation outcome in the coronary care unit

The use of dispatcher assistance in improving the quality of cardiopulmonary resuscitation: A randomised controlled trial

AIMS

The introduction of dispatcher assistance (DA) services has led to increased bystander cardiopulmonary resuscitation (CPR) participation rates. However, the extent to which DA improves CPR quality remains unclear. This study aimed to evaluate the efficacy of DA in improving CPR quality among healthcare professionals and laypersons within a multi-ethnic Southeast Asian population.

METHODS

A parallel, randomised controlled, open label trial was performed. Four hundred and twelve participants were recruited via convenience sampling in a public location. In a simulated cardiac-arrest scenario, the participants were randomised to perform CPR with DA over the phone (DA+) or CPR without DA (DA-). The ratio of participant assignment to DA+ and DA- was 1:1. The primary outcomes were CPR compression depth, compression rate, no-flow time, complete release of pressure between compressions, and hand location. The assessment involved CPR manikins and human assessors.

RESULTS

A larger proportion of participants in DA + achieved the correct compression rate (34.3% vs 18.1%, p < 0.001). There was no difference in the other primary outcomes. A subgroup analysis revealed that healthcare professionals in DA+ had a higher proportion of correct hand location compared to those in DA- (82.1% vs. 53.5%, p < 0.05). There was no significant difference in CPR quality among laypersons with valid CPR certification regardless of whether they received DA.

CONCLUSION

DA should be provided to laypersons without valid CPR certification, as well as healthcare professionals. The identification of gaps in the current DA protocol highlights areas where specific changes can be made to improve CPR quality.

Do-not-resuscitate Order: The Experiences of Iranian Cardiopulmonary Resuscitation Team Members

Background:

One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR). This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order.

Methods:

CPR team members were interviewed, and data were analyzed using a conventional content analysis method.

Results:

Three categories and six subcategories emerged: “The dilemma between revival and suffering” with the subcategories of “revival likelihood” and “death as a cause for comfort;” “conflicting situation” with the subcategories of “latent decision” and “ambivalent order;” and “low-quality CPR” with the subcategories of “team member demotivation” and “disrupting CPR performance.”

Conclusion:

There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR.

An ethical analysis of cardiopulmonary resuscitation for elders in acute care

Despite empirical evidence that cardiopulmonary resuscitation (CPR) is of questionable effectiveness in elders with comorbidities, it continues to hold a unique place in the armamentarium of life-sustaining treatments in that consent for CPR is implied and, when needed, is administered emergently. These conditions of implied consent and emergency implementation often preclude an opportunity for patients/surrogates, in conjunction with their nurses and physicians, to determine the appropriateness of the intervention, given the patient's medical and functional status. Healthcare providers who perform CPR on elderly patients often find themselves in morally distressing circumstances because of their anecdotal knowledge of poor outcomes and realization that a multitude of barriers has precluded an anticipatory discussion regarding appropriateness of the treatment. Nurses and other healthcare providers must take the lead in helping patients/surrogates appreciate the meaning of CPR as a life-sustaining intervention and ensure that each patient's situation receives the ethical reflection deserved for each individual as a matter of human dignity.

The compliance of doctors and nurses with do-not-resuscitate orders in Germany and Sweden

A questionnaire based on a case-scenario offering three levels of available information about the patients' wishes was circulated with the objective to evaluate compliance with do-not-resuscitate orders (DNR) and advance directives (AD) from a cross-cultural perspective. Replies from 191 doctors and 182 nurses from Germany and 104 doctors and 122 nurses from Sweden were studied. The frequency of cardiopulmonary resuscitation (CPR) performed against the patients wishes varied between 32.5% (German doctors for DNR-scenario) and 8.3% (Swedish nurses for AD-scenario). The variance regarding the CPR decision could be explained by the help obtained by increasing information regarding the patients wishes and preferred treatment options. Since compliance is related to detailed information given by the patient the use of DNRs and ADs should be encouraged to a larger extent.