Decision-making in cardiac arrest: physicians’ and nurses’ knowledge and views on terminating resuscitation
Received 9 August 2018
Accepted for publication 19 November 2018
Published 20 December 2018 Volume 2019:11 Pages 1—8
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Hans-Christoph Pape
Camilla Hansen,1–3 Kasper G Lauridsen,1–3 Anders S Schmidt,1–3 Bo Løfgren1,2,4,5
1Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; 2Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark; 3Clinical Research Unit, Randers Regional Hospital, Randers, Denmark; 4Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 5Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
Introduction: Many cardiopulmonary resuscitation (CPR) attempts are unsuccessful and must be terminated. On the contrary, premature termination results in a self-fulfilling prophecy. This study aimed to investigate 1) physicians’ self-assessed competence in terminating CPR, 2) physicians’ and nurses’ knowledge of the European Resuscitation Council guidelines on termination, and 3) single factors leading to termination.
Methods: Questionnaires were distributed at advanced cardiac life support (ACLS) courses at a university hospital in Denmark. Participants included ACLS health care providers, ie, physicians and nurses from cardiac arrest teams, intensive care and anesthetic units or medical wards with a duty to provide ACLS. Physicians were divided into junior physicians (house officers) and experienced physicians (specialist registrars and consultants).
Results: Overall, 308 participants responded (104 physicians and 204 nurses, response rate: 98%). Among physicians, 37 (36%) did not feel competent to decide when to terminate CPR (junior physicians: n=16, 64%, compared with experienced physicians: n=21, 28%, P=0.002). Two (2%) physicians and one (0.5%) nurse were able to state the contents of termination guidelines. Several factors were reported to impact termination, including absence of a pupillary light reflex (physicians: 17%, nurses: 22%) and cardiac standstill on echocardiography (physicians: 18%, nurses: 20%). Moreover, nine (9%) physicians and 35 (17%) nurses would terminate prolonged CPR despite a shockable rhythm present.
Conclusion: One-third of all physicians did not feel competent to decide when to terminate CPR. Physicians’ and nurses’ knowledge of termination guidelines was poor, and both professions reported unvalidated or controversial factors as a single reason for terminating CPR.
Keywords: resuscitation, ethics, end-of-life decision, living will, medical decision-making
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