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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
P. Druwé, KG. Monsieurs, R. Piers, J. Gagg, S. Nakahara, EA. Alpert, H. van Schuppen, G. Élő, A. Truhlář, SA. Huybrechts, N. Mpotos, LM. Joly, T. Xanthos, M. Roessler, P. Paal, MN. Cocchi, C. BjØrshol, M. Pauliková, J. Nurmi, PP. Salmeron, R....
Jazyk angličtina Země Irsko
Typ dokumentu časopisecké články, multicentrická studie, práce podpořená grantem
- MeSH
- celosvětové zdraví MeSH
- dospělí MeSH
- kardiopulmonální resuscitace škodlivé účinky statistika a číselné údaje MeSH
- klinické rozhodování MeSH
- lidé středního věku MeSH
- lidé MeSH
- percepce MeSH
- postoj zdravotnického personálu MeSH
- procedury zbytečné psychologie statistika a číselné údaje MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- urgentní zdravotnické služby metody statistika a číselné údaje MeSH
- zástava srdce mimo nemocnici mortalita terapie MeSH
- zbytečná diagnóza a terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
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.
Akureyri Hospital and University of Akureyri Akureyri Iceland
Department of Anaesthesiology and Intensive Therapy Medical University of Gdansk Gdansk Poland
Department of Anaesthesiology and Intensive Therapy Semmelweis University Budapest Hungary
Department of Anaesthesiology University Medical Centre Göttingen Göttingen Germany
Department of Anesthesiology Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
Department of Anesthesiology and Critical Care Medicine University Hospital Innsbruck Austria
Department of Anesthesiology and Intensive Care East Slovak Institute of Oncology Košice Slovakia
Department of Emergency Medicine Antwerp University Hospital Antwerp Belgium
Department of Emergency Medicine Cork University Hospital Cork Republic of Ireland
Department of Emergency Medicine Ghent University Hospital Ghent Belgium
Department of Emergency Medicine Rouen University Hospital Rouen France
Department of Geriatric Medicine Ghent University Hospital Ghent Belgium
Department of Intensive Care Medicine Ghent University Hospital Ghent Belgium
Emergency Department Shaare Zedek Medical Center Jerusalem Israel
Emergency Medicine and Services Helsinki University Hospital Helsinki Finland
European University Nicosia Cyprus Hellenic Society of Cardiopulmonary Resuscitation Athens Greece
Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
Hospital General Universitario Reina Sofia Murcia Spain
Municipal Institute for Emergency Medicine Novi Sad Serbia
Nicosia General Hospital Nicosia Cyprus
Pontificia Universidad Católica de Chile Santiago Chile
Teikyo University School of Medicine Tokyo Japan
University of Medicine and Pharmacy Gr T Popa and Emergency County Hospital Sf Spiridon Iasi Romania
Citace poskytuje Crossref.org
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- $a Druwé, Patrick $u Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: patrick.druwe@ugent.be.
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- $a Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional survey / $c P. Druwé, KG. Monsieurs, R. Piers, J. Gagg, S. Nakahara, EA. Alpert, H. van Schuppen, G. Élő, A. Truhlář, SA. Huybrechts, N. Mpotos, LM. Joly, T. Xanthos, M. Roessler, P. Paal, MN. Cocchi, C. BjØrshol, M. Pauliková, J. Nurmi, PP. Salmeron, R. Owczuk, H. Svavarsdóttir, C. Deasy, D. Cimpoesu, M. Ioannides, PA. Fuenzalida, L. Kurland, V. Raffay, G. Pachys, B. Gadeyne, J. Steen, S. Vansteelandt, P. De Paepe, DD. Benoit,
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- $a 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.
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