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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

(2018) RESUSCITATION. 132. p.112-119
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Abstract
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.
Keywords
Cardiac arrest, Out-of-hospital, Cardiopulmonary resuscitation, Inappropriate care, Perception, HOSPITAL CARDIAC-ARREST, REPORTED PATIENT-CARE, SURVIVAL, BURNOUT, LIFE, PROVIDERS, DECISIONS, OUTCOMES, TRENDS, NURSES

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MLA
Druwé, Patrick, Koenraad G. Monsieurs, Ruth Piers, et al. “Perception of Inappropriate Cardiopulmonary Resuscitation by Clinicians Working in Emergency Departments and Ambulance Services : the REAPPROPRIATE International, Multi-centre, Cross Sectional Survey.” RESUSCITATION 132 (2018): 112–119. Print.
APA
Druwé, P., Monsieurs, K. G., Piers, R., Gagg, J., Nakahara, S., Alpert, E. A., van Schuppen, H., et al. (2018). Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services : the REAPPROPRIATE international, multi-centre, cross sectional survey. RESUSCITATION, 132, 112–119.
Chicago author-date
Druwé, Patrick, Koenraad G. Monsieurs, Ruth Piers, James Gagg, Shinji Nakahara, Evan Avraham Alpert, Hans van Schuppen, et al. 2018. “Perception of Inappropriate Cardiopulmonary Resuscitation by Clinicians Working in Emergency Departments and Ambulance Services : the REAPPROPRIATE International, Multi-centre, Cross Sectional Survey.” Resuscitation 132: 112–119.
Chicago author-date (all authors)
Druwé, Patrick, Koenraad G. Monsieurs, Ruth Piers, James Gagg, Shinji Nakahara, Evan Avraham Alpert, Hans van Schuppen, Gábor Élő, Anatolij Truhlář, Sofie A. Huybrechts, Nicolas Mpotos, Luc-Marie Joly, Theodoros Xanthos, Markus Roessler, Peter Paal, Michael N. Cocchi, Conrad BjØrshol, Monika Pauliková, Jouni Nurmi, Pascual Piñera Salmeron, Radoslaw Owczuk, Hildigunnur Svavarsdóttir, Conor Deasy, Diana Cimpoesu, Marios Ioannides, Pablo Aguilera Fuenzalida, Lisa Kurland, Violetta Raffay, Gal Pachys, Bram Gadeyne, Johan Steen, Stijn Vansteelandt, Peter De Paepe, and Dominique Benoit. 2018. “Perception of Inappropriate Cardiopulmonary Resuscitation by Clinicians Working in Emergency Departments and Ambulance Services : the REAPPROPRIATE International, Multi-centre, Cross Sectional Survey.” Resuscitation 132: 112–119.
Vancouver
1.
Druwé P, Monsieurs KG, Piers R, Gagg J, Nakahara S, Alpert EA, et al. Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services : the REAPPROPRIATE international, multi-centre, cross sectional survey. RESUSCITATION. 2018;132:112–9.
IEEE
[1]
P. Druwé et al., “Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services : the REAPPROPRIATE international, multi-centre, cross sectional survey,” RESUSCITATION, vol. 132, pp. 112–119, 2018.
@article{8585813,
  abstract     = {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.},
  author       = {Druwé, Patrick and Monsieurs, Koenraad G. and Piers, Ruth and Gagg, James and Nakahara, Shinji and Alpert, Evan Avraham and van Schuppen, Hans and Élő, Gábor and Truhlář, Anatolij and Huybrechts, Sofie A. and Mpotos, Nicolas and Joly, Luc-Marie and Xanthos, Theodoros and Roessler, Markus and Paal, Peter and Cocchi, Michael N. and BjØrshol, Conrad and Pauliková, Monika and Nurmi, Jouni and Salmeron, Pascual Piñera and Owczuk, Radoslaw and Svavarsdóttir, Hildigunnur and Deasy, Conor and Cimpoesu, Diana and Ioannides, Marios and Fuenzalida, Pablo Aguilera and Kurland, Lisa and Raffay, Violetta and Pachys, Gal and Gadeyne, Bram and Steen, Johan and Vansteelandt, Stijn and De Paepe, Peter and Benoit, Dominique},
  issn         = {0300-9572},
  journal      = {RESUSCITATION},
  keywords     = {Cardiac arrest,Out-of-hospital,Cardiopulmonary resuscitation,Inappropriate care,Perception,HOSPITAL CARDIAC-ARREST,REPORTED PATIENT-CARE,SURVIVAL,BURNOUT,LIFE,PROVIDERS,DECISIONS,OUTCOMES,TRENDS,NURSES},
  language     = {eng},
  pages        = {112--119},
  title        = {Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services : the REAPPROPRIATE international, multi-centre, cross sectional survey},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2018.09.006},
  volume       = {132},
  year         = {2018},
}

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