The outcomes of cardiopulmonary resuscitation and their predictors during the coronavirus 2019 pandemic in Iran.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can negatively affect different healthcare-related outcomes. Nonetheless, there is limited information about its effects on different healthcare-related outcomes. This study aimed at evaluating the outcomes of cardiopulmonary resuscitation (CPR) and their predictors during the COVID-19 pandemic in Iran. METHODS: This cross-sectional study was conducted on 1253 patients who had undergone CPR in the emergency wards of teaching hospitals in the west of Iran from the beginning of the first wave to the end of the third epidemic wave of COVID-19 in Iran, between February 20, 2020, and January 20, 2021. Data were collected using the National CPR Documentation Forms developed based on the Utstein Style and routinely used for all patients with cardiac arrest (CA). The SPSS (v. 20.0) program was used to analyze the data through the Chi-square, Fisher's exact, and Mann-Whitney U tests and logistic regression analysis. RESULTS: Participants' age mean was 64.62 ± 17.54 years. Age mean among participants with COVID-19 was eight years more than other participants. Most participants were male (64.09%) and had at least one underlying disease (64.99%). The total rates of the return of spontaneous circulation (ROSC) and CPR-discharge survival were respectively 15.3% and 3.8% among all participants, 20.25% and 5.17% among participants without COVID-19, and 8.96% and 2.04% among participants with COVID-19. The significant predictors of ROSC were age, affliction by COVID-19, affliction by underlying diseases, baseline rhythm, delay in epinephrine administration, and epinephrine administration time interval, while the significant predictors of CPR-discharge survival were age and baseline rhythm. CONCLUSIONS: The total rates of ROSC and CPR-discharge survival were respectively 15.3% and 3.8% among all participants. The rates of ROSC and CPR to discharge survival among patients without COVID-19 are respectively 2.26 and 2.53 times more than the rates among patients with COVID-19.

Survival to Discharge Rate and Favorable Neurological Outcome Related to Gender, Duration of Resuscitation and First Document of Patients In-Hospital Cardiac Arrest: A Systematic Meta-Analysis.

Objective: To investigate the relationship between outcomes and demographic-clinical variables in in-hospital cardiac arrest (IHCA). Methods: The Medline database was searched along with Google Scholar, Scopus, Web of Science, and Persian language database without time limitation until January 6th, 2020. The inclusion criteria included papers published in journals or presented in English and Persian congress that reported the IHCA outcomes based on the Utstein criterion. All the descriptive, cross-sectional, and cohort studies on CPR were covered based on inclusion and exclusion criteria. Primary checks covered titles and abstracts followed by a full-text check of the remaining papers from the first screening stage. Data analysis was done using comprehensive meta-analysis (CMA) software version 2.0. The finding's heterogeneity was checked using Q and Cochran tests with heterogeneity >50% and the random-effects model was used to estimate survival and favorable neurological outcome (FNO) in the analysis. To detect the publication bias of studies, the subgroup test, meta-regression test, sensitivity analysis test, funnel plot, and Eagger's regression test were used. Results: Survival to discharge was 19.1% (95% CI=16.8-21.7) and FNO in the survived to discharge cases was 68.1% (95% CI=55.8-78.3). Survival to discharge and FNO were notably higher in men, CPR duration <15min, and shockable dysrhythmias. Conclusion: IHCA outcomes are poor in developing countries. The outcomes of IHCA in terms of gender were inconsistent with the result reported by other meta-analyses.

Healthcare providers' experiences in hospital resuscitation of patients with COVID-19: a qualitative study.

BACKGROUND: The COVID-19 epidemic has globally challenged medical practices, including cardiopulmonary resuscitation (CPR). Numerous challenges affect healthcare providers (HCPs) who are members of the resuscitation team and the resuscitation process in COVID-19 patients. As a result, HCPs may experience different dilemmas about CPR. Failure to recognize these experiences can harm both HCPs and patients. This study aimed to explore the HCP's experiences of CPR in patients with COVID-19. METHODS: A qualitative study was conducted using semi-structured interviews with 26 participants in the emergency departments of Besat, Golestan, and Imam Reza hospitals (in the west of Iran) using the hermeneutic phenomenology approach. The data were analyzed using the 6-step Smith interpretative phenomenological analysis (IPA) method. RESULTS: The mean age of the participants was 38 years. Most of them (61.5%) were male and had a Bachelor's degree in nursing (46.1%).The data analysis resulted in extracting four super-ordinate and nine sub-ordinate themes. "Human aspects of Care", "Perceived Psychological Effects of Resuscitation in COVID-19", "HCP's perceptions of factors affecting the resuscitation process in COVID-19", and "Perceived differences in COVID-19 resuscitation compared to non-COVID patients" were super-ordinate themes. CONCLUSIONS: The participants experienced a wide range of difficult feelings and emotions while resuscitating the patients with COVID-19, suggesting the effect of the COVID-19 epidemic on HCPs and the resuscitation process. They experienced stress and fear, and the resuscitation process was influenced by their compassion, underlying patient conditions, resuscitation futility, and participants' fatigue or lack of oxygen due to the use of personal protective equipment (PPE).

Knowledge, Attitude and Decision-making of Nurses in the Resuscitation Team towards Terminating Resuscitation and Do-not-Resuscitate Order.

Background: Making appropriate decisions for cardiopulmonary resuscitation (CPR) is very challenging for healthcare providers. This study aimed to evaluate knowledge, attitude, and decision making about do-not-resuscitate (DNR) and termination of resuscitation (ToR) among nurses in the resuscitation team. Methods: This descriptive cross-sectional study was conducted in April-September 2020. Participants were 128 nurses from the CPR teams of two hospitals in Kermanshah and Hamedan, Iran. A valid and reliable researcher-made instrument was used for data collection. Data were analyzed using the Chi-square, Fisher's exact, and Mann-Whitney U tests, the Spearman's correlation analysis, and the logistic and rank regression analyses. Results: Only 22.7% and 37.5% of participants had adequate knowledge about ToR and DNR. The significant predictor of DNR and ToR knowledge was educational level and the significant predictors of decision making for CPR were educational level, gender, and history of receiving CPR-related education (P<0.05). When facing a cardiac arrest and indication of DNR or ToR, 12.5% of participants reported that they would not start CPR, 21.5% of them reported that they would terminate CPR, and 14.8% of them reported that they would perform slow code. The DNR decision had significant relationship with educational level, DNR knowledge, and ToR knowledge (P< 0.05), while the ToR decision had significant relationship with educational level and ToR knowledge (P<0.05). Conclusion: Nurses' limited DNR and ToR knowledge and physicians' conflicting orders and documentation can cause ethical challenges for nurses. Clear guidelines for DNR orders or TOR is necessary for nurses, in order to prevent any potential confusion, legal or psychosocial issues and concerns surrounding CPR and improve their involvement in CPR decision making process.

Cardiopulmonary Resuscitation Outcomes of Patients with COVID-19; a One-Year Survey.

INTRODUCTION: Assessing cardiopulmonary resuscitation (CPR) outcomes of patients with COVID-19 and employing effective strategies for their improvement are essential. This study is designed in this regard. METHODS: This cross-sectional study was conducted between January 20, 2020 and January 20, 2021 in the emergency departments of two hospitals in Hamadan and Kermanshah, Iran. Participants were 487 patients with confirmed COVID-19 and cardiac arrest (CA) who had undergone CPR during the study period. Data were collected using the available CPR documentation forms developed based on the Utstein Style and analyses were performed using Chi-square, Fisher's exact, and Mann-Whitney U tests and the logistic regression analysis. RESULTS: Participants' mean age was 69.31±14.73 years and most of them were male (61.8%) and suffered from at least one underlying disease (58.1%). The rate of total and in-hospital CA was 9.67% and 9.39%, respectively. The most prevalent first documented rhythm was asystole (67.9%) and the highest responsivity to CPR was for shockable rhythms. The rate of the return of spontaneous circulation (ROSC) was 9% and the rate of survival to hospital discharge was 2%. The significant predictors of CPR success were age (p = 0.035), epinephrine administration time interval (p = 0.00), CPR duration (p = 0.00), and First documented rhythm (p = 0.009). CONCLUSION: The rate of in-hospital CA among studied COVID-19 cases was 9.39% with 9% ROSC and 2% survival to hospital discharge rates after CPR. Primary CPR success among patients with COVID-19 was poor, particularly among those with asystole and bradycardia. It seems that old age and improper doses of epinephrine can reduce CPR success.

Assessing the effect of arrival time of physician and cardiopulmonary resuscitation (CPR) team on the outcome of CPR.

Introduction: Negligence of proper time and poor performance of resuscitation team can lead to more mortality and negative consequences of cardiac arrest, as well as less survival. This study was conducted with objective of determining the arrival time of physician and resuscitation team to survive the victims of cardiopulmonary arrest. Materials and methods: In this prospective and descriptive-analytic study, the resuscitation performance and the arrival time of resuscitation team in 143 inpatients who had been diagnosed with witnessed cardiopulmonary arrest were examined using a researcher-made checklist. Data analysis was performed using parametric and non-parametric statistical tests and SPSS. Results: Initial survival rate was 26.6%. In general, the mean time of physician's presence after the code announcement in minutes and seconds was 02:31 ± 01:22. It was also 02:24 ± 01:15 in successful cases and 02:34 ± 01:25 in unsuccessful cases. Independent t-test did not show a significant difference between the physician's presence time and the rate of initial successful resuscitation (p = 0.504). The time of first shock after observing ventricular fibrillation/tachycardia (in minutes and seconds) was 01:30 ± 00:47. According to independent t-test, the aforementioned time was less than the mean time (02:31 ± 01:22) of physician's presence (p < 0.001). Conclusions: In this study, the initial survival rate in comparison to other regions in the country was almost more favorable and it was similar to global norms. In this study, the starting time of resuscitation was within the acceptable range. There was no relationship between the presence of physician and the initial survival rate of patients, as well as the use of defibrillator (by physician compared to other team members) and intubation with the initial survival rate. This could indicate the adequate performance of resuscitation team in the absence of physician on the condition of having sufficient knowledge and skill.

Geographic Information System (GIS) capabilities in traffic accident information management: a qualitative approach.

BACKGROUND: Traffic accidents are one of the more important national and international issues, and their consequences are important for the political, economical, and social level in a country. Management of traffic accident information requires information systems with analytical and accessibility capabilities to spatial and descriptive data. OBJECTIVE: The aim of this study was to determine the capabilities of a Geographic Information System (GIS) in management of traffic accident information. METHODS: This qualitative cross-sectional study was performed in 2016. In the first step, GIS capabilities were identified via literature retrieved from the Internet and based on the included criteria. Review of the literature was performed until data saturation was reached; a form was used to extract the capabilities. In the second step, study population were hospital managers, police, emergency, statisticians, and IT experts in trauma, emergency and police centers. Sampling was purposive. Data was collected using a questionnaire based on the first step data; validity and reliability were determined by content validity and Cronbach's alpha of 75%. Data was analyzed using the decision Delphi technique. RESULTS: GIS capabilities were identified in ten categories and 64 sub-categories. Import and process of spatial and descriptive data and so, analysis of this data were the most important capabilities of GIS in traffic accident information management. CONCLUSION: Storing and retrieving of descriptive and spatial data, providing statistical analysis in table, chart and zoning format, management of bad structure issues, determining the cost effectiveness of the decisions and prioritizing their implementation were the most important capabilities of GIS which can be efficient in the management of traffic accident information.

Study of survival rate after cardiopulmonary resuscitation (CPR) in hospitals of Kermanshah in 2013.

BACKGROUND: After CPR, the follow-up of survival rate and caused complications are the most important practices of the medical group. This study was performed aimed at determining the follow-up results after CPR in patients of university hospitals in Kermanshah in 2014. METHODS: In this prospective study, 320 samples were examined. A purposive sampling method was used, and data was collected using a researcher-made information form with content and face validity and reliability of r= 0.79. Data was analyzed with STATA9 software and statistical tests, including calculation of the success rate, relative risk (RR), chi-square and Fisher at significance level of P < 0.05. RESULTS: The initial success rate of cardiopulmonary resuscitation was equal to 15.3%, while the ultimate success rate (discharged alive from the hospital) was as 10.6%. The six-month success rate after resuscitation was 8.78% than those who were discharged alive. There were no significant statistical differences between different age groups regarding the initial success rate of resuscitation (P = 0.14), and the initial resuscitation success rate was higher in patients in morning shift (P = 0.02). CONCLUSION: By the results of study, it is recommended to increase the medical - nursing knowledge and techniques for personnel in the evening and night shifts. Also, an appropriate dissemination of health care staff in working shifts should be done to increase the success rate of CPR procedure.