Cardiopulmonary Resuscitation Attempts Research Articles

Paramedic utility in screening patients who present to Emergency Medical Services and who may benefit from an Advance Care Plan: A mixed methods study with explanatory sequential design

We used a two-phased mixed methods study with an explanatory sequential design to understand how frequently paramedics attend patients who, on paramedic assessment with the Gold Standards Framework Proactive Identification Guidance, are end-of-life and have advance care planning. We subsequently explored paramedic views on paramedic screening of patients to assess if they are end-of-life and onward referral to their General Practitioner for advance care planning. Paramedics screened and recorded 14.9% of patients as end-of-life and 44.3% of these patients were assessed to have no advance care plan in place. When paramedics screened patients and they did have an advance care plan in place, 36.8% had only a Do Not Attempt Cardiopulmonary Resuscitation. Paramedics found using the Gold Standards Framework Proactive Identification Guidance to screen patients for end-of-life status useful and straightforward and considered themselves well-placed to complete this task. Future research is required to address the practicalities of implementing a paramedic screening and referral tool for end-of-life care that results in the intended outcome of supporting effective advance care planning.

Does a Transition to Single-Occupancy Patient Rooms Affect the Incidence and Outcome of In-Hospital Cardiac Arrests?

It is proposed that patients in single-occupancy patient rooms (SPRs) carry a risk of less surveillance by nursing and medical staff and that resuscitation teams need longer to arrive in case of in-hospital cardiac arrest (IHCA). Higher incidences of IHCA and worse outcomes after cardiopulmonary resuscitation (CPR) may be the result. Our study examines whether there is a difference in incidence and outcomes of IHCA before and after the transition from a hospital with multibedded rooms to solely SPRs. In this prospective observational study in a Dutch university hospital, as a part of the Resuscitation Outcomes in the Netherlands study, we reviewed all cases of IHCA on general adult wards in a period of 16.5 months before to 16.5 months after the transition to SPRs. During the study period, 102 CPR attempts were performed: 51 in the former hospital and 51 in the new hospital. Median time between last-seen-well and start basic life support did not differ significantly, nor did median time to arrival of the CPR team. Survival rates to hospital discharge were 30.0% versus 29.4% of resuscitated patients (p = 1.00), with comparable neurological outcomes: 86.7% of discharged patients in the new hospital had Cerebral Performance Category 1 (good cerebral performance) versus 46.7% in the former hospital (p = .067). When corrected for telemetry monitoring, these differences were still nonsignificant. The transition to a 100% SPR hospital had no negative impact on incidence, survival rates, and neurological outcomes of IHCAs on general adult wards.

1743 Frailty is associated with poor cardiopulmonary resuscitation outcomes in the COVID-19 pandemic

Abstract Background This study aims to investigate the relationship between frailty and in-hospital cardiopulmonary resuscitation (CPR) outcomes in the COVID-19 pandemic. Methods The study was carried out in a tertiary hospital in Scotland and included all patients over the age of 18 who had an in-hospital CPR attempt between April 2020 and March 2022. Patients were identified via the pre-existing National Cardiac Arrest Audit Database which was collected prospectively. Data collected from this included age, sex, initial arrest rhythm, return of spontaneous circulation (ROSC) and in-hospital mortality. The electronic and paper patient notes were retrospectively reviewed to calculate a Rockwood clinical frailty scale (CFS) and Charlson comorbidity index (CCI). The data was stratified in to frail (CFS ≥5) and non-frail (CFS <5) groups. Results 65 patients were included in the study. In univariate analysis, there was a significant difference between the frail and non-frail groups in age (p=0.006), ROSC (p=0.02) and survival to discharge (p=0.004). Only 10 out of 34 (29.4%) frail patients had ROSC and of those only 3 (8.8%) survived to discharge compared to 12 out of 31 (35.3%) of non-frail patients. In a binary logistic regression, there was a significant association between frailty and both ROSC (adjusted OR 3.31 [95% CI: 1.12-9.78}) and survival to discharge (adjusted OR 6.33 [95% CI: 1.48-27.13]) and no significant association with age, CCI or sex. Conclusion The findings support the relationship between frailty and poor CPR outcomes independent of age and co-morbidity during the COVID-19 pandemic.

GPs' views on emergency care treatment plans: an online survey.

A holistic approach to emergency care treatment planning is needed to ensure that patients' preferences are considered should their clinical condition deteriorate. To address this, emergency care and treatment plans (ECTPs) have been introduced. Little is known about their use in general practice. To find out GPs' experiences of, and views on, using ECTPs. Online survey of GPs practising in England. A total of 841 GPs were surveyed using the monthly online survey provided by medeConnect, a market research company. Forty-one per cent of responders' practices used Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans for ECTP, 8% used other ECTPs, and 51% used Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms. GPs were the predominant professional group completing ECTPs in the community. There was broad support for a wider range of community-based health and social care professionals being able to complete ECTPs. There was no system for reviewing ECTPs in 20% of responders' practices. When compared with using a DNACPR form, GPs using a ReSPECT form for ECTP were more comfortable having conversations about emergency care treatment with patients (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.1 to 2.69) and family members (OR =1.85, 95% CI = 1.19 to 2.87). The potential benefits and challenges of widening the pool of health and social care professionals initiating and/or completing the ECTP process needs consideration. ReSPECT plans appear to make GPs more comfortable with ECTP discussions, supporting their implementation. Practice-based systems for reviewing ECTP decisions should be strengthened.

Intensive care following in-hospital cardiac arrest / periarrest calls—experience from one Scottish hospital

BackgroundIn-hospital cardiac arrest/periarrest is a recognised trigger for consideration of admission to the intensive care unit (ICU). We aimed to investigate the rates of ICU admission following in-hospital cardiac arrest/periarrest, evaluate the outcomes of such patients and assess whether anticipatory care planning had taken place prior to the adult resuscitation team being called.MethodsAnalysis of all referrals to the ICU page-holder within our district general hospital is between 1st November 2018 and 31st May 2019. From this, the frequency of adult resuscitation team calls was determined. Case notes were then reviewed to determine details of the events, patient outcomes and the use of anticipatory care planning tools on wards.ResultsOf the 506 referrals to the ICU page-holder, 141 (27.9%) were adult resuscitation team calls (114 periarrests and 27 cardiac arrests). Twelve patients were excluded due to health records being unavailable. Admission rates to ICU were low — 17.4% for cardiac arrests (4/23 patients), 5.7% (6/106) following periarrest. The primary reason for not admitting to ICU was patients being “too well” at the time of review (78/129 — 60.5%). Prior to adult resuscitation team call, treatment escalation plans had been completed in 27.9% (36/129) with Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms present in 15.5% of cases (20/129). Four cardiac arrest calls were made in the presence of a valid DNACPR form, frequently due to a lack of awareness of the patient’s resuscitation status.ConclusionsThis study highlights the significant workload for the ICU page-holder brought about by adult resuscitation team calls. There is a low admission rate from these calls, and, at the time of resuscitation team call, anticipatory planning is frequently either incomplete or poorly communicated. Addressing these issues requires a collaborative approach between ICU and non-ICU physicians and highlights the need for larger studies to develop scoring systems to aid objective admission decision-making.

Family Medicine Residents' Knowledge and Attitudes About End-of-Life Care in Taif City, Saudi Arabia.

Background End-of-life care is essential for individuals with advanced illness and their families, providing comfort, symptom control, and dignity in the final year of life. Additionally, physician competence requires the ability to communicate, make decisions, and create relationships in end-of-life care. This study assesses family physicians' knowledge and attitude regarding end-of-life care in Taif, Saudi Arabia. Methods Thisdescriptive cross-sectional study conducted between October and November 2021 assessed the knowledge and attitudes of 163 family physicians in Taif City, Saudi Arabia, regarding end-of-life care. Using a convenient sampling technique, an adapted and validated questionnaire was administered electronically, collecting sociodemographic information and assessing participants' knowledge and attitudes. Data were analyzed using descriptive statistics in Statistical Product and Service Solutions (SPSS, version 28) (IBM SPSS Statistics for Windows, Armonk, NY). Results Findings included that 41.1% of residents believed the patient and family should be informed about diagnoses and prognoses in advanced diseases. At the same time, attitudes varied, with 45.4% agreeing that discussing such information could lead to patient depression and 42.9% believing it held no privilege for patients. Additionally, 57.7% recognized that grief reactions would occur, but patients would eventually adjust, and 44.8% agreed that discussing diagnoses would decrease patient anxiety. However, limited awareness of advance directives was evident, with 12.3% reporting being well aware and 45.4% having never heard of them. There was uncertainty and hesitancy regarding Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, with 39.9% being well aware and 46% having heard of it without a strong understanding. Conclusion The findings revealed a mixed landscape, with physicians demonstrating awareness of the importance of transparent communication but needing more knowledge in areas such as advance directives and complex decision-making. The study highlighted the need for targeted education to address these gaps and promote a more informed and consistent approach to end-of-life care.

77 Introducing a Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) and treatment escalation plan (TEP) guideline in an acute hospital.

Abstract Background In hospital cardiopulmonary resuscitation has a 13–20% survival rate to hospital discharge. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders reduce resuscitation activity in people who are unlikely to survive due to underlying co-morbidities. The project aimed to identify current DNACPR practice and cardiac arrest calls in an acute care hospital and to improve communicating and documentation of DNACPR decisions. Methods A baseline audit of 20 medical charts identified variable practice on documenting DNACPR, inappropriate cardiac arrest calls and poor communication between the multidisciplinary team and patients on DNACPR decisions. A sub-committee of Medical Clinical Governance developed a hospital wide Guideline and Proforma for DNACPR that included a treatment escalation plan (TEP). Using quality improvement methodology and plan-do-study-act cycles the DNACPR proforma and decision support framework was refined and tested. Implementation strategies included stakeholder engagement, education, re-formatting documentation and recruitment of ward champions over a six month period. Post implementation audit measured compliance with completing the proforma and resuscitation calls. Results Clinical audit in February 2023 of 33 patient medical records identified 100% (n = 33) of patients with a DNACPR decision had the correct form in use. 96% documented communication with patients. All proformas were signed by a senior decision maker, included a TEP and were filed correctly in the patients notes. There was a 25% reduction in cardiac arrest calls. Only 56% of proformas were signed by nursing staff. Conclusion Implementing a standardised DNACPR proforma was feasible and improved documentation, visibility and ease of locating DNACPR decisions. It promoted timely communication with patients and families setting realistic goals of care in the TEP. In turn there has been a reduction in cardiac arrest calls. Nurses role in the process remains sub-optimal and there is a need to understand the experience of patients and families.

A fatal case of paediatric post-traumatic pyomyositis.

A 6-year-old girl was brought to the emergency department with a history of an accidental fall a few days earlier. She presented with a fever, cough and constipation. Sars-CoV-2 infection being suspected, she was transferred to a paediatric facility for Covid-positive patients. During the diagnostic process, the clinical picture suddenly deteriorated with the development of bradycardia, tachypnea and altered sensorium. Despite cardiopulmonary resuscitation attempts, the child died about 16 hours after admission to the emergency department. A judicial forensic autopsy was performed that concluded that her death was due to multiple acute pulmonary, cardiac and renal infarctions secondary to septic thromboembolism in the course of post-traumatic bacterial necrotizing pyomyositis of the right ileo-psoas muscle.

'That's as hard a decision as you will ever have to make': the experiences of people who discussed Do Not Attempt Cardiopulmonary Resuscitation on behalf of a relative during the COVID-19 pandemic.

COVID-19 brought additional challenges to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision-making, which was already a contentious issue. In the UK, reports of poor DNACPR decision-making and communication emerged in 2020, including from the regulator, the Care Quality Commission. This paper explores the experiences of people who discussed DNACPR with a healthcare professional on behalf of a relative during the coronavirus pandemic, with the aim of identifying areas of good practice and what needs to be improved. a total of 39 people participated in semi-structured interviews via video conferencing software or telephone. Data were evaluated using Framework Analysis. results are presented around three main themes: understanding, communication and impact. Participants' understanding about DNACPR was important, as those with better understanding tended to reflect more positively on their discussions with clinicians. The role of relatives in the decision-making process was a frequent source of misunderstanding. Healthcare professionals' communication skills were important. Where discussions went well, relatives were given clear explanations and the opportunity to ask questions. However many relatives felt that conversations were rushed. DNACPR discussions can have a lasting impact-relatives reported them to be significant moments in care journeys. Many relatives perceived that they were asked to decide whether their relative should receive CPR and described enduring emotional consequences, including guilt. the pandemic has illuminated deficiencies in current practice around DNACPR discussion, which can have difficult to anticipate and lasting negative consequences for relatives. This research raises questions about the current approach to DNACPR decision-making.

Should AEDs Become More Common in Nursing Homes?

Automated external defibrillators, or AEDs, to manage cardiac arrest have become standard in many community settings. This was evident when first responders had to perform cardiopulmonary resuscitation (CPR) and use an AED on Buffalo Bills safety Damar Hamlin, who went into cardiac arrest on the football field in January. By contrast, AEDs are not standard in nursing homes. Nursing facilities that participate in Medicare and Medicaid must be able to provide basic life support (BLS), including CPR, in emergency situations, but they are not required to have AEDs on-site, and the extent of AED use is unknown. It may be time to re-evaluate CPR procedures among residents, says Rebecca Elon, MD, MPH, CMD, an associate professor at Johns Hopkins University School of Medicine. Previously, studies suggested that performing CPR on nursing home residents who experience cardiac arrest is futile, given that the likelihood of survival lessens as individuals age. One study, for instance, found that over a 13-year period, survival 30 days after CPR was performed was 6.7% among individuals aged 70 to 79, dropping to 4.4% among those aged 80 to 89 and 2.4% among those aged 90 and older (Resuscitation 2015;94:28–32). Studies also have found poorer outcomes in individuals who have comorbidities, even when an AED was used. However, Dr. Elon points out, many of those studies are more than a decade old. The most recent study dates to 2006, and none of the individuals in that study received CPR with an AED. Indeed, in four U.S. cities only 6.7% of nursing homes had AEDs, and 10% had manual defibrillators, as reported by another study that same year (J Am Med Direc Assoc 2006;7:413–415). When cardiac arrest occurs, the rate of survival diminishes by about 10% for every minute between the arrest and initiation of CPR, and the risk of prolonged brain damage increases due to cerebral hypoxia. However, recent studies have shown that outcomes have improved when someone witnesses the cardiac arrest and performs CPR using an AED. For example, a 2018 study in Denmark found that between 2001 and 2014, the overall survival in a limited cohort went from 1.7% to 7.7% when a bystander witnessed the cardiac arrest, performed CPR, and used an AED while awaiting emergency medical services (Resuscitation 2018;125:90–98). A German study of nursing facilities in 2020 found that among 2,900 CPR attempts over a seven-year period, only 118 patients (4.4%) were alive when they later left the hospital; 64 of those individuals (2.2% of the total) had a favorable cerebral performance (Dtsch Arztebl Int 2020;117:757–763). The researchers also found that in 64% of those cases the nursing staff did not attempt to resuscitate the resident but instead waited for the arrival of emergency personnel. Besides clinical outcomes, there are other considerations when deciding whether AEDs should be standard in nursing homes, such as staff time, especially considering shortages, and cost effectiveness. “Despite these various potential concerns, providing AEDs for nursing facility staff to utilize in the BLS/CPR protocols might prove to be an important quality-improvement intervention and risk-management tool for nursing facilities,” Dr. Elon writes. Source: Elon RD. Cardiac Resuscitation Procedures in US Nursing Facilities: Time to Reevaluate the Standard of Care? [published online: February 28, 2023]. J Am Med Dir Assoc. DOI: https://doi.org/10.1016/j.jamda.2023.01.029. Jeffrey S. Eisenberg, a freelance writer in the Philadelphia area, compiled this listing.

Cardiac Resuscitation Procedures in US Nursing Facilities: Time to Reevaluate the Standard of Care?

Although the use of automated external defibrillators (AEDs) in out-of-hospital cardiac arrest (OHCA) response has become the standard of care in many community settings over the past 20+ years, the adoption of AEDs in US nursing facilities is variable and the current number of facilities with AEDs is unknown. Recent research into the use of AEDs as part of cardiopulmonary resuscitation (CPR) procedures for nursing facility residents with sudden cardiac arrest demonstrates improved outcomes in the limited cohort with witnessed arrests, early bystander CPR, and an initial amenable rhythm, shocked with an AED before the arrival of Emergency Medical Services (EMS) personnel. This article reviews data about outcomes of CPR in older adults and nursing facility settings and proposes that standard procedures for CPR attempts in US nursing facilities should be reevaluated and continue to evolve, commensurate with the evidence and community standards.

Managing DNACPR Recommendations in Residential Care: Towards Improved Training for Social Care and Capacity Professionals

Abstract The use of ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) recommendations has come under scrutiny during the COVID-19 pandemic, and the Care Quality Commission (CQC) has issued a call for new standards, guidance and training. One group for whom new training is required is ‘capacity professionals’ working in and with residential care facilities. These professionals (including Independent Mental Capacity Advocates and Best Interests Assessors) typically have a social work background and have specialist training regarding the 2005 Mental Capacity Act, the provisions of which have a direct relevance to DNACPR recommendations. We report on a survey and focus groups that probed the experiences of this professional group during the pandemic. We recruited 262 participants by approaching civil society organisations in which capacity professionals are well represented; twenty-two participated in follow-on focus groups. We used manifest content analysis and descriptive statistics to analyse the results. Our findings contribute to an emerging picture of what transpired in residential care homes during the first year of the pandemic and help to provide an empirical and normative basis for the development of the new guidance and training for which the CQC has called.

The success rate of cardiopulmonary resuscitation and its correlated factors in patients with emergency prehospital cardiac arrest

ABSTRACT To assess the initial success rate and its correlated factors on cardiopulmonary resuscitation (CPR) in emergency prehospital cardiac arrest patients. The clinical information of 429 patients with cardiac arrest who underwent prehospital CPR in the fourth hospital of Hebei Medical University from Jan 2020 to Apr 2022 were evaluated. The patients were divided into the successful group (ROSC, n = 25) and the unsuccessful group (non-ROSC, n = 404) according to whether the autonomous circulation (ROSC) was resumed. The univariate analysis was performed to evaluate the differences in age, the start time of CPR, the application of electric defibrillation, and other related data between the two groups. The multivariate analysis evaluated protective factors affecting CPR’s success in prehospital cardiac arrest patients. Patients with cardiogenic causes had the highest success rate of cardiopulmonary resuscitation. The causes of traffic accidents and drowning account for a low proportion. Furthermore, the median CPR length was 25.0 min, alternating from 1.5 to 64 mi. The univariate analysis revealed that age, the start time of CPR, application of electric defibrillation, and adrenaline dosage were correlated with CPR attempts (p < 0.05). Multivariate logistic regression analysis showed that the age of patients with prehospital CA, the location of prehospital CA, etiology, bystander CPR, CPR start time, defibrillation start time, tracheal intubation time, type of rhythm before resuscitation, adrenaline dosage <5 mg, and adrenaline administration time were all the influencing factors of prehospital CPR success (p < 0.01). The factors affecting CPR’s success rate in prehospital CA patients are complicated. Establishing a few procedures to diminish the incidence of these risk factors is crucial.

Readiness of Teachers of General Education Institutions to Perform Cardiopulmonary Resuscitation

RELEVANCE The problem of sudden cardiac arrest and sudden death among the students of educational institutions is highly relevant for the Russian Federation. In order to plan interventions aimed at improving effectiveness of management and reducing mortality from cardiac arrest in educational institutions, a clear understanding of level of readiness and motivation of teachers to provide help to a cardiac arrest victim is necessary. AIM OF STUDY To evaluate willingness of teachers of general education institutions to provide cardiopulmonary resuscitation (CPR) in cases of cardiac arrest, and to investigate factors and relationships that determine readiness of teachers to give help. MATERIAL AND METHODS In February–March 2021, an online questionnaire survey of teaching staff of general education institutions was conducted in the Republic of Crimea. As part of the survey, respondents were asked to evaluate their willingness to attempt CPR on a loved one, a stranger or a pupil on a five-point Likert scale, and to indicate potential barriers for performing CPR. The survey was voluntary and anonymous. RESULTS The questionnaire was completed by 5,921 teachers. Of all respondents, 9.2% were males, 31.6% — aged over 50 years, 32.3% — work in urban areas. The proportion of teachers who expressed absolute willingness to perform CPR on a loved one, a stranger or a pupil was 63.6% (n=3,766), 34.8% (2,058) and 41.0% (2,427), respectively. At the same time, 13.6% (804), 31.0% (1,836) and 30.6% (1,809), respectively, indicated that they would probably not or definitely not attempt CPR. A high readiness to perform resuscitation (4–5 points) was confirmed to be associated with previous CPR training (p&lt;0.001) and with higher level of CPR knowledge (p≤0.006). The main barriers to providing resuscitation were “lack of CPR knowledge and skills” (indicated by 31.4–36.3% of the respondents depending on the type of presumed cardiac arrest victim) and “fear of causing harm to a victim” (49.2–51.4%). CONCLUSION Considerable portion of teachers of general education institutions demonstrate low level of readiness to provide life-saving help in case of cardiac arrest. Lack of CPR knowledge and skills constitute the main barrier to attempting resuscitation. In order to improve survival from cardiac arrest in educational institutions, comprehensive organisational interventions are required, which should primarily focus on ensuring full coverage of teachers with high-quality training and retraining in resuscitation.

Impact of the COVID-19 pandemic on prehospital characteristics and outcomes of out-of-hospital cardiac arrest among the elderly in Japan: A nationwide study

AimTo assess the impact of the 2020 coronavirus disease (COVID-19) pandemic on the prehospital characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in the elderly. MethodsIn this population-based nationwide observational study in Japan, 563,100 emergency medical service-unwitnessed OHCAs in elderly (≥65 years) patients involving any prehospital resuscitation efforts were analysed (144,756, 140,741, 140,610, and 136,993 cases in 2020, 2019, 2018, and 2017, respectively). The epidemiology, characteristics, and outcomes associated with OHCAs in elderly patients were compared between 3 years pre-pandemic (2017–2019) and the pandemic year (2020). The primary outcome was neurologically favourable one-month survival. The secondary outcomes were the rate of bystander cardiopulmonary resuscitation (CPR), defibrillation by a bystander, dispatcher-assisted (DA)-CPR attempts, and one-month survival. ResultsDuring the pandemic year, the rates of neurologically favourable 1-month survival (crude odds ratio, 95% confidence interval: 1.19, 1.14–1.25), bystander CPR (1.04, 1.03–1.06), and DA-CPR attempts (1.10, 1.08–1.11) increased, whereas the incidence of public access defibrillation (0.88, 0.83–0.93) decreased. Subgroup analyses based on interaction tests showed that the increased rate of neurologically favourable survival during the pandemic year was enhanced in OHCA at care facilities (1.51, 1.36–1.68) and diminished or abolished on state-of-emergency days (0.90, 0.74–1.09), in the mainly affected prefectures (1.08, 1.01–1.15), and in cases with shockable initial rhythms (1.03, 0.96–1.12). ConclusionsThe COVID-19 pandemic increased the bystander CPR rate in association with enhanced DA-CPR attempts and improved the outcomes of elderly patients with OHCAs.

Preparing for end-of-life: learning from Do Not Attempt Cardiopulmonary Resuscitation decision-making during COVID-19.

During the COVID-19 pandemic, Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were made differently. This included more prominent roles for specialties such as psychiatry and doctors in training. Concerns about inappropriate DNAR decisions led to anxiety for doctors, patients and the public. Positive outcomes may have included earlier and better-quality end-of life-discussions. However, COVID-19 exposed the need for support, training and guidance in this area for all doctors. It also highlighted the importance of effective public education about advanced care planning.

Do not attempt cardiopulmonary resuscitation - ethical aspects

Introduction. ?Do Not Attempt Cardiopulmonary Resuscitation? is a clear decision not to initiate resuscitation in the final stages of the disease. This decision shall be made if it is assessed that health will not be improved after resuscitation, and it can be made by the patient, family, or the medical team. Informed patient consent - ?Code status?. Informed patient consent or ?Code status? refers to the type of medical treatment the patient wants medical personnel to apply or not to apply in case of cardiac arrest. Patients make a decision about no resuscitated while they are in a situation to consciously make decisions, or authorize family members or guardians to make and implement such a decision for them. There might be a problem with patients and their families not fully understanding the meaning and the process of resuscitation, the prognosis, risks, and consequences. They do not understand the terms of short-term and long-term survival rates and post-resuscitation quality of life. Do not attempt Cardiopulmonary Resuscitation. According to the current guidelines from the European Resuscitation Council, a joint decision on cardiopulmonary resuscitation planned in advance should be the first priority from the ethical standpoint. The decision-making team should take into account the patient?s wishes when making the decision about cardiopulmonary resuscitation, thus, the end-of-life discussions with patients are necessary. The practice of ethics. It is necessary to know when to start and when to stop with cardiopulmonary resuscitation. Several criteria need to be taken into account when making a decision not to initiate cardiopulmonary resuscitation. One unambiguous criterion is the safety of the rescuer. Conclusion. Continuous research is also needed to improve knowledge in this area and facilitate decision-making and improve post-resuscitation survival and quality of life for these patients.

Cardiopulmonary Resuscitation (CPR) during COVID-19 Pandemic

Introduction: The COVID-19 infection has a high rate of mortality and morbidity and is extremely contagious. COVID-19 has raised attention to safety issues involving healthcare workers who perform CPR. The risk of transmission produces a dilemma to perform cardiopulmonary resuscitation (CPR) within the COVID-19 pandemic. Additionally, patient and/or family preferences, as a factor associated with Do-Not-Resuscitate (DNR). This commentary wants to provide an overview or other perspectives that may be the subject of further research so that there will be evidence base practice for health workers, especially nurses in code blue situations. Discussion: COVID-19 pandemic has clearly had a significant impact on the epidemiology and outcome of cardiac arrest in both out-of-hospital and in-hospital settings. All potential COVID-19 patients should be offered the advantage of CPR by attempting to revive them after taking all required safety precautions, and the patient should only be confirmed dead after CPR has been performed. Provision of further information regarding CPR to patients and/or families for consideration, including the advantages and disadvantages of CPR, before making a final decision regarding the administration of CPR. COVID-19 patients with a poor prognosis might benefit from Do-Not-Resuscitate (DNR) but this is causes dilemmas in nursing profession. Conclusion: Although the survival rate for COVID-19 patients is poor, it is anticipated that CPR attempts will still be performed during the COVID-19 pandemic by following several guidelines. COVID-19 patients with a poor prognosis might benefit from Do-Not-Resuscitate (DNR) if the patient and/or family who are accountable provide their approval and everything is in order. As a nurse, we must respect the decisions that patients or families make because it is their right and their authority.

A more conservative test of sex differences in the treatment and outcome of in-hospital cardiac arrest

BackgroundStudies investigating sex disparities related to treatment and outcome of in-hospital cardiac arrest (IHCA) have produced divergent findings and have typically been unable to adjust for outstanding confounding variables. ObjectivesThe aim was to examine sex differences in treatment and survival following IHCA, using a comprehensive set of control variables including e.g., age, comorbidity, and patient-level socioeconomic status. MethodsThis retrospective study was based on data from the Swedish Register of Cardiopulmonary Resuscitation and Statistics Sweden. In the primary analyses, logistic regression models and ordinary least square regressions were estimated. ResultsThe study included 24,217 patients and the majority (70.4%) were men. In the unadjusted analyses, women had a lower chance of survival after cardiopulmonary resuscitation (CPR) attempt, at hospital discharge (with good neurological function) and at 30 days (p<0.01). In the adjusted regression models, female sex was associated with a higher chance of survival after the CPR attempt (B = 1.09, p<0.01) and at 30-days (B = 1.09, p<0.05). In contrast, there was no significant association between sex and survival to discharge with good neurological outcome. Except for treatment duration (B=-0.07, p<0.01), no significant associations between sex and treatment were identified. ConclusionsNo signs of treatment disparities or discrimination related to sex were identified. However, women had a better chance of surviving IHCA compared to men. The finding that women went from having a survival disadvantage (unadjusted analysis) to a survival advantage (adjusted analysis) attests to the importance of including a comprehensive set of control variables, when examining sex differences.

A case of massive pulmonary embolism causing cardiac arrest managed with successful systemic thrombolytic in the emergency department

Pulmonary Embolism (PE), when complicated by cardiac arrest, is almost always fatal despite all resuscitative efforts. However, a more favorable is possible when PE is rapidly identified as the cause of cardiac arrest and pulmonary circulation is quickly re-established by specific therapy. A 54-year-old woman was brought to the Emergency Department (ED) by 112 emergency ambulance service with the complaint of shortness of breath that had started 2 hours ago. She developed cardiac arrest while being physical examined 2 minutes after admission, and Cardiopulmonary Resuscitation (CPR) was immediately begun. Massive PE was considered the most likely diagnosis in the light of her history, physical examined, and bedside ultrasonography findings; thus, recombinant tissue Plasminogen Activator (r-tPA) was administered during CPR. The second CPR attempt achieved return of spontaneous circulation within 5 minutes. She was treated at intensive care unit for 32 days and discharged from the hospital with complete recovery.