Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional survey

Patrick Druwé; 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; Johan Steen; Stijn Vansteelandt; Peter De Paepe; Dominique D Benoit

doi:https://doi.org/10.1016/j.resuscitation.2018.09.006

Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional survey

Patrick Druwé, 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 SalmeronRadoslaw Owczuk, Hildigunnur Svavarsdóttir, Conor Deasy, Diana Cimpoesu, Marios Ioannides, Pablo Aguilera Fuenzalida, Lisa Kurland, Violetta Raffay, Gal Pachys, Johan Steen, Stijn Vansteelandt, Peter De Paepe, Dominique D Benoit

Research output: Contribution to journal › Article › Academic › peer-review

27 Citations (Scopus)

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.

Original language	English
Pages (from-to)	112-119
Journal	Resuscitation
Volume	132
DOIs	https://doi.org/10.1016/j.resuscitation.2018.09.006
Publication status	Published - 2018

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https://doi.org/10.1016/j.resuscitation.2018.09.006

Cite this

Druwé, P., Monsieurs, K. G., Piers, R., Gagg, J., Nakahara, S., Alpert, E. A., van Schuppen, H., Élő, G., Truhlář, A., Huybrechts, S. A., Mpotos, N., Joly, L.-M., Xanthos, T., Roessler, M., Paal, P., Cocchi, M. N., BjØrshol, C., Pauliková, M., Nurmi, J., ... Benoit, D. D. (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. https://doi.org/10.1016/j.resuscitation.2018.09.006

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title = "Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional survey",

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 = "Patrick Druw{\'e} and Monsieurs, {Koenraad G} and Ruth Piers and James Gagg and Shinji Nakahara and Alpert, {Evan Avraham} and {van Schuppen}, Hans and G{\'a}bor {\'E}l{\H o} and Anatolij Truhl{\'a}{\v r} and Huybrechts, {Sofie A} and Nicolas Mpotos and Luc-Marie Joly and Theodoros Xanthos and Markus Roessler and Peter Paal and Cocchi, {Michael N} and Conrad Bj{\O}rshol and Monika Paulikov{\'a} and Jouni Nurmi and Salmeron, {Pascual Pi{\~n}era} and Radoslaw Owczuk and Hildigunnur Svavarsd{\'o}ttir and Conor Deasy and Diana Cimpoesu and Marios Ioannides and Fuenzalida, {Pablo Aguilera} and Lisa Kurland and Violetta Raffay and Gal Pachys and Johan Steen and Stijn Vansteelandt and {De Paepe}, Peter and Benoit, {Dominique D}",

year = "2018",

doi = "https://doi.org/10.1016/j.resuscitation.2018.09.006",

language = "English",

volume = "132",

pages = "112--119",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

}

Druwé, P, Monsieurs, KG, Piers, R, Gagg, J, Nakahara, S, Alpert, EA, van Schuppen, H, Élő, G, Truhlář, A, Huybrechts, SA, Mpotos, N, Joly, L-M, Xanthos, T, Roessler, M, Paal, P, Cocchi, MN, BjØrshol, C, Pauliková, M, Nurmi, J, Salmeron, PP, Owczuk, R, Svavarsdóttir, H, Deasy, C, Cimpoesu, D, Ioannides, M, Fuenzalida, PA, Kurland, L, Raffay, V, Pachys, G, Steen, J, Vansteelandt, S, De Paepe, P & Benoit, DD 2018, '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. https://doi.org/10.1016/j.resuscitation.2018.09.006

Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional survey. / Druwé, Patrick; Monsieurs, Koenraad G; Piers, Ruth et al.
In: Resuscitation, Vol. 132, 2018, p. 112-119.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services

T2 - The REAPPROPRIATE international, multi-centre, cross sectional survey

AU - Druwé, Patrick

AU - Monsieurs, Koenraad G

AU - Piers, Ruth

AU - Gagg, James

AU - Nakahara, Shinji

AU - Alpert, Evan Avraham

AU - van Schuppen, Hans

AU - Élő, Gábor

AU - Truhlář, Anatolij

AU - Huybrechts, Sofie A

AU - Mpotos, Nicolas

AU - Joly, Luc-Marie

AU - Xanthos, Theodoros

AU - Roessler, Markus

AU - Paal, Peter

AU - Cocchi, Michael N

AU - BjØrshol, Conrad

AU - Pauliková, Monika

AU - Nurmi, Jouni

AU - Salmeron, Pascual Piñera

AU - Owczuk, Radoslaw

AU - Svavarsdóttir, Hildigunnur

AU - Deasy, Conor

AU - Cimpoesu, Diana

AU - Ioannides, Marios

AU - Fuenzalida, Pablo Aguilera

AU - Kurland, Lisa

AU - Raffay, Violetta

AU - Pachys, Gal

AU - Steen, Johan

AU - Vansteelandt, Stijn

AU - De Paepe, Peter

AU - Benoit, Dominique D

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

U2 - https://doi.org/10.1016/j.resuscitation.2018.09.006

DO - https://doi.org/10.1016/j.resuscitation.2018.09.006

M3 - Article

C2 - 30218746

SN - 0300-9572

VL - 132

SP - 112

EP - 119

JO - Resuscitation

JF - Resuscitation

ER -