Experiences of family-witnessed cardiopulmonary resuscitation in hospital and its impact on life: An interview study with cardiac arrest survivors and their family members.

AIM: To explore experiences of cardiac arrest in-hospital and the impact on life for the patient who suffered the arrest and the family member who witnessed the resuscitation. BACKGROUND: Guidelines advocate that the family should be offered the option to be present during resuscitation, but little is known about family-witnessed cardiopulmonary resuscitation in hospital and the impact on the patient and their family. DESIGN: A qualitative design consisting of joint in-depth interviews with patients and family members. METHODS: Family interviews were conducted with seven patients and their eight corresponding family members (aged 19-85 years) 4-10 months after a family-witnessed in-hospital cardiac arrest. Data were analysed using interpretative phenomenological analysis. The study followed the guidelines outlined in the consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS: The participants felt insignificant and abandoned following the in-hospital cardiac arrest. Surviving patients and their close family members felt excluded, alone and abandoned throughout the care process; relationships, emotions and daily life were affected and gave rise to existential distress. Three themes and eight subordinate themes were identified: (1) the intrusion of death-powerless in the face of the fragility of life, highlights what it is like to suffer a cardiac arrest and to cope with an immediate threat to life; (2) being totally exposed-feeling vulnerable in the care relationship, describes how a lack of care from healthcare staff damaged trust; (3) learning to live again-making sense of an existential threat, pertaining to the family's reactions to a difficult event that impacts relationships but also leads to a greater appreciation of life and a positive view of the future. CONCLUSION: Surviving and witnessing a cardiac arrest in-hospital is a critical event for everyone involved. Patients and family members are vulnerable in this situation and need to be seen and heard, both in the hospital and after hospital discharge. Consequently, healthcare staff need to show compassion and attend to the needs of the family, which involves continually assessing how family members are coping during the process, and providing support and information during and after resuscitation. RELEVANCE TO CLINICAL PRACTICE: It is important to provide support to family members who witness the resuscitation of a loved one in-hospital. Structured follow-up care is crucial for cardiac arrest survivors and their families. To promote person-centred care, nurses need interprofessional training on how to support family members during resuscitation, and follow-up care focusing on providing resources for multiple challenges faced by survivors (emotional, cognitive, physical) and families (emotional) is needed. PATIENT OR PUBLIC CONTRIBUTION: In-hospital cardiac arrest patients and family members were involved when designing the study.

What the curtains do not shield: A phenomenological exploration of patient-witnessed resuscitation in hospital. Part 1: patients' experiences.

AIMS: The aim of the study was to explore the experiences of hospital patients who witnessed resuscitation of a fellow patient. DESIGN: Descriptive phenomenology. METHODS: Patients who witnessed resuscitation were recruited from nine clinical wards in a university hospital in England. Data were collected through face-to-face individual interviews. Participants were interviewed twice,in 1 week and 4 to 6 weeks after the resuscitation event. Data were collected between August 2018 and March 2019. Interviews were analysed using Giorgi's phenomenological analysis. RESULTS: Sixteen patients participated in the first interview and two patients completed follow-up interviews. Three themes were developed from the patients' interviews. (1) Exposure to witnessing resuscitation: patients who witness resuscitation felt exposed to a distressing event and not shielded by bed-space curtains, but after the resuscitation attempt, they also felt reassured and safe in witnessing staff's response. (2) Perceived emotional impact: patients perceived an emotional impact from witnessing resuscitation and responded with different coping mechanisms. (3) Patients' support needs: patients needed information about the resuscitation event and emotional reassurance from nursing staff to feel supported, but this was not consistently provided. CONCLUSION: The presence of other patients during resuscitation events must be acknowledged by healthcare professionals, and sufficient information and emotional support must be provided to patients witnessing such events. This study generates new evidence to improve patients' experience and healthcare professionals' support practices. IMPACT: The phenomenon of patient-witnessed resuscitation requires the attention of healthcare professionals, resuscitation officers and policymakers. Study findings indicate that witnessing resuscitation has an emotional impact on patients. Strategies to support them must be improved and integrated into the management of in-hospital resuscitation. These should include providing patients with comprehensive information and opportunities to speak about their experience; evacuating mobile patients when possible; and a dedicated nurse to look after patients witnessing resuscitation events.

Characteristics of surfers as bystander rescuers in Europe.

INTRODUCTION: Coastal locations contribute significantly to global drowning, with surfers frequently conducting rescues. This study explored the characteristics of surfers as bystander rescuers in Europe. METHODS: A cross-sectional online survey collected demographics (age, sex, geographical location), surfing experience, ability, lifesaving and cardiopulmonary resuscitation (CPR) training, information seeking behaviors and previous performance of a rescue. Analyses comprised descriptive frequencies, binomial logistic regression with adjusted odds ratio (AOR) (95% confidence interval [CI]) and chi-squares (p < .05). RESULTS: Europe-dwelling respondents totaled 1705 (76% male; 43% 25-34 years). Thirty-nine percent (39.2%; n = 668) had previously performed a rescue. Likelihood of having conducted a rescue significantly increased with 6 or more years of surfing experience (6-10 years [AOR = 1.96; 95%CI: 1.20-3.22]; 11-15 years [AOR = 3.26; 95%CI: 1.56-6.79]; 16 years or more [AOR = 4.27; 95%CI: 2.00-9.11]) when compared to surfers with <1 year experience. Expert/professional ability surfers were 10.89 times (95%CI: 4.72-25.15) more likely to have conducted a rescue than novice/beginners. Respondents who had received both a certified lifeguard and CPR course were significantly more likely to have conducted a rescue (AOR = 3.34; 95%CI: 2.43-4.60). CONCLUSION: Surfers who had previously conducted rescues commonly had more years of experience, higher self-rated surf ability and greater likelihood of having received certified training. However, not all surfers who have performed rescues had received training. Findings suggest surfers should receive rescue and CPR training before they start surfing at locations without trained supervision and refresh training regularly. Surfers are amenable to injury prevention information, especially online and via apps.

Attitude and behavior toward bystander cardiopulmonary resuscitation during COVID-19 outbreak.

BACKGROUND: Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on bystander cardiopulmonary resuscitation (BCPR) for fear of transmission while breaking social distancing rules. The latest guidelines recommend hands-only cardiopulmonary resuscitation (CPR) and facemask use. However, public willingness in this setup remains unknown. METHODS: A cross-sectional, unrestricted volunteer Internet survey was conducted to assess individuals' attitudes and behaviors toward performing BCPR, pre-existing CPR training, occupational identity, age group, and gender. The raking method for weights and a regression analysis for the predictors of willingness were performed. RESULTS: Among 1,347 eligible respondents, 822 (61%) had negative attitudes toward performing BCPR. Healthcare providers (HCPs) and those with pre-existing CPR training had fewer negative attitudes (p < 0.001); HCPs and those with pre-existing CPR training and unchanged attitude showed more positive behaviors toward BCPR (p < 0.001). Further, 9.7% of the respondents would absolutely refuse to perform BCPR. In contrast, 16.9% would perform BCPR directly despite the outbreak. Approximately 9.9% would perform it if they were instructed, 23.5%, if they wore facemasks, and 40.1%, if they were to perform hands-only CPR. Interestingly, among the 822 respondents with negative attitudes, over 85% still tended to perform BCPR in the abovementioned situations. The weighted analysis showed similar results. The adjusted predictors for lower negative attitudes toward BCPR were younger age, being a man, and being an HCP; those for more positive behaviors were younger age and being an HCP. CONCLUSIONS: Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on attitudes and behaviors toward BCPR. Younger individuals, men, HCPs, and those with pre-existing CPR training tended to show fewer negative attitudes and behaviors. Meanwhile, most individuals with negative attitudes still expressed positive behaviors under safer measures such as facemask protection, hands-only CPR, and available dispatch instructions.

Resuscitation à la Carte: Ethical Concerns About the Practice and Theory of Partial Codes.

We describe a request for CPR without chest compressions from a patient's daughter. Requests for partial codes raise numerous clinical concerns, including lack of evidence-based effectiveness, risk of medical error, and difficulty in communication. These in turn lead to ethical concerns, including a misapplication of respect for patient autonomy, violating the foundational principle of "first do no harm," and inconsistency with the tenets of shared decision-making. Many requests for partial codes are also based on a conflation of cardiopulmonary arrest and pre-arrest emergencies. We argue physicians have no ethical obligation to honor a request for a partial code and that doing so does not violate respect for patient autonomy. Requests for partial codes should be seen as a request for information about CPR and an invitation to conversation. We also report here the move our health system made to only offer evidence-based code status options and reject those with negligible likelihood for therapeutic benefit. This work included limiting options for code status to "Full Code" or "Do Not Attempt Resuscitation," creating an order set for non-arrest emergencies, and sample language to guide physicians in responding to requests for partial codes. To assist other hospitals or health systems considering this move, we provide the content of the order set for non-arrest emergencies and the sample language guide.

Knowledge and perceptions of cardiopulmonary resuscitation amongst New Zealand podiatrists: a web-based survey.

BACKGROUND: Podiatrists in New Zealand have a duty of care to assist patients in an emergency, and current cardiopulmonary resuscitation (CPR) certification is a requirement for registration. However, it is unknown how competent and confident podiatrists are in administering CPR and how they would respond in an emergency. Having a health professional who has a competent knowledge of CPR and skills in basic life support, can improve survival rates from sudden cardiac arrest. Therefore, the aim of this study was to survey New Zealand podiatrists to determine their CPR knowledge and qualifications; beliefs about the application of CPR; and perceptions of their competency in CPR. METHODS: This cross-sectional study used a web-based survey. Participants were New Zealand registered podiatrists with a current annual practising certificate. The 31-item survey included questions to elicit demographic information, CPR practice and attitudes, and CPR knowledge. Responses were collected between March and August 2020. RESULTS: 171 podiatrists responded to the survey. 16 % of the podiatrists (n = 28) had performed CPR in an emergency, with a 50 % success rate. Participants were predominantly female (n = 127, 74 %) and working in private practice (n = 140,82 %). Nearly half of respondents were younger than 40 years (n = 75,44 %) and had less than 10 years of clinical experience (n = 73, 43 %). Nearly all (n = 169,97 %) participants had received formal CPR training in the past two years, with 60 % (n = 105) receiving training in the past 12 months. Most respondents (n = 167,98 %) self-estimated their CPR ability as being effective, very effective, or extremely effective. Participants' knowledge of CPR was variable, with the percentage of correct answers for CPR protocol statements ranging between 20 and 90 %. CONCLUSIONS: This study provides the first insight into New Zealand podiatrists' CPR knowledge and perceptions. Podiatrists were found to have high levels of CPR confidence but demonstrated gaps in CPR knowledge. Currently, New Zealand registered podiatrists require biennial CPR re-certification. However, resuscitation authorities in New Zealand and overseas recommend an annual update of CPR skills. Based on this study's findings, and in line with Australia and the United Kingdom, the authors recommend a change from biennial to annual CPR re-certification for podiatrists in New Zealand. TRIAL REGISTRATION: The study was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12620001144909 ).

Those Special Moments Nurses Sometimes Talk About.

Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely-and often more personal-perspectives on professional, policy, and clinical issues. Best of the Blog is a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.

Reanimación cardiopulmonar presenciada por los familiares. Estudio para implementar un programa RCP-PF en un hospital / Cardiopulmonary resuscitation witnessed by family members. Study to implement a CPR-FP program in a hospital

La presencia de familiares durante la reanimación cardiopulmonar (RCP) está ampliamente aceptada desde los años 80, pero la realidad es que el número de países europeos que la aceptan prácticamente no ha cambiado los últimos años (10/32 en adultos y 13/32 en niños). El 80% de los profesionales suelen ser reticentes a dicha presencia, alegando que pueden alterar el correcto desarrollo de la reanimación y puede ser contraproducente para profesionales y los familiares. En general los pediatras y las enfermeras suelen estar más a favor de la presencia de dichos familiares que los responsables de reanimación de adultos. Se realiza una encuesta a los profesionales de dos centros españoles para valorar, por una parte, su opinión sobre la RCP presenciada por los familiares (RCP-PF), y por otra, si creen factible implementar un programa de este tipo en su centro de trabajo. Resultados: a pesar de que más del 80% de profesionales encuestados invitan a los familiares a retirarse de la escena de la RCP, un tercio de los mismos ve factible la puesta en marcha de dicho programa en su centro y casi la mitad estarían dispuestos a colaborar en dicha implementación (AU)

The presence of family members during cardiopulmonary resuscitation (CPR) has been widely accepted since the 1980s, but the reality is that the number of European countries that accept it has practically not changed in recent years (10/32 in adults and 13/32 in children). 80% of professionals are usually reluctant to such presence, claiming that they can alter the correct development of resuscitation and can be counterproductive for professionals and their families. In general, pediatricians and nurses tend to be more in favor of the presence of these relatives than those responsible for resuscitation of adults. A survey is carried out among professionals from two Spanish centers to assess, on the one hand, their opinion about CPR witnessed by relatives (FP-CPR) and on the other if they believe it is feasible to implement a FP-CPR program in their hospital. Results: Despite the fact that more than 80% of the professionals surveyed invite family members to leave the CPR scene, a third of them see the implementation of FP-CPR program in their center as feasible and almost half would be willing to collaborate (AU)

La presència de familiars durant la reanimació cardiopulmonar (**RCP) està àmpliament acceptada des dels anys 80, però la realitat és que el nombre de països europeus que l'accepten pràcticament no ha canviat els últims anys (10/32 en adults i 13/32 en nens). El 80% dels professionals solen ser reticents a aquesta presència, al·legant que poden alterar el correcte desenvolupament de la reanimació i pot ser contraproduent per a professionals i els familiars. En general els pediatres i les infermeres solen estar més a favor de la presència d'aquests familiars que els responsables de reanimació d'adults. Es realitza una enquesta als professionals de dos centres espanyols per a valorar, d'una banda, la seva opinió sobre la RCP presenciada pels familiars (RCP-*PF), i per una altra, si creuen factible implementar un programa d'aquest tipus en el seu centre de treball. Resultats: a pesar que més del 80% de professionals enquestats conviden als familiars a retirar-se de l'escena de la RCP, un terç dels mateixos veu factible la posada en marxa d'aquest programa en el seu centre i gairebé la meitat estarien disposats a col·laborar en aquesta implementació (AU)

Physicians' Characteristics Associated with Their Attitude to Family Presence during Adult Cardiopulmonary Resuscitation.

Healthcare providers have disparate views of family presence during cardiopulmonary resuscitation; however, the attitudes of physicians have not been investigated systematically. This study investigates the patterns and determinants of physicians' attitudes to FP during cardiopulmonary resuscitation in Saudi Arabia. A cross-sectional design was applied, where a sample of 1000 physicians was surveyed using a structured questionnaire. The study was conducted in the southern region of Saudi Arabia for over 11 months (February 2014-December 2014). The collected data was analyzed using the Pearson chi-square test. Spearman's correlation analysis and chi-square test of independence were used for the analysis of physicians' characteristics with their willingness to allow FP. 80% of physicians opposed FP during cardiopulmonary resuscitation. The majority of them believed that FP could lead to decreased bedside space, staff distraction, performance anxiety, interference with patient care, and breach of privacy. They also highlight FP to result in difficulty concerning stopping a futile cardiopulmonary resuscitation, psychological trauma to family members, professional stress among staff, and malpractice litigations. 77.9% mostly disagreed that FP could be useful in allaying family anxiety about the condition of the patient or removing their doubts about the care provided, improving family support and participation in patient care, or enhancing staff professionalism. Various concerns exist for FP during adult cardiopulmonary resuscitation, which must be catered when planning for FP execution.

RNA-seq analysis of the key long noncoding RNAs and mRNAs related to cognitive impairment after cardiac arrest and cardiopulmonary resuscitation.

Cardiac arrest (CA) is the leading cause of death around the world. Survivors after CA and cardiopulmonary resuscitation (CPR) develop moderate to severe cognitive impairment up to 60% at 3 months. Accumulating evidence demonstrated that long non-coding RNAs (lncRNAs) played a pivotal role in ischemic brain injury. This study aimed to identify potential key lncRNAs associated with early cognitive deficits after CA/CPR. LncRNA and mRNA expression profiles of the hippocampus in CA/CPR or sham group were analyzed via high-throughput RNA sequencing, which exhibited 1920 lncRNAs and 1162 mRNAs were differentially expressed. These differentially expressed genes were confirmed to be primarily associated with inflammatory or apoptotic signaling pathways through GO and KEGG pathway enrichment analysis and coding-noncoding co-expression network analysis. Among which, five key pairs of lncRNA-mRNA were further analyzed by qRT-PCR and western blot. We found that the lncRNANONMMUT113601.1 and mRNA Shc1, an inflammation and apoptosis-associated gene, exhibited the most significant changes in hippocampus of CA/CPR mice. Furthermore, we found that the correlations between this lncRNA and mRNA mainly happened in neurons of hippocampus by in situ hybridization. These results suggested that the critical pairs of lncRNA-mRNA may act as essential regulators in early cognitive deficits after resuscitation.

Housestaff perceptions on training and discussing the Maryland Orders for Life Sustaining Treatment Form (MOLST).

BACKGROUND: On-line tutorials are being increasingly used in medical education, including in teaching housestaff skills regarding end of life care. Recently an on-line tutorial incorporating interactive clinical vignettes and communication skills was used to prepare housestaff at Johns Hopkins Hospital to use the Maryland Orders for Life Sustaining Treatment (MOLST) form, which documents patient preferences regarding end of life care. 40% of housestaff who viewed the module felt less than comfortable discussing choices on the MOLST with patients. We sought to understand factors beyond knowledge that contributed to housestaff discomfort in MOLST discussions despite successfully completing an on-line tutorial. METHODS: We conducted semi-structured telephone interviews with 18 housestaff who completed the on-line MOLST training module. Housestaff participants demonstrated good knowledge of legal and regulatory issues related to the MOLST compared to their peers, but reported feeling less than comfortable discussing the MOLST with patients. Transcripts of interviews were coded using thematic analysis to describe barriers to using the MOLST and suggestions for improving housestaff education about end of life care discussions. RESULTS: Qualitative analysis showed three major factors contributing to lack of housestaff comfort completing the MOLST form: [1] physician barriers to completion of the MOLST, [2] perceived patient barriers to completion of the MOLST, and [3] design characteristics of the MOLST form. Housestaff recommended a number of adaptations for improvement, including in-person training to improve their skills conducting conversations regarding end of life preferences with patients. CONCLUSIONS: Some housestaff who scored highly on knowledge tests after completing a formal on-line curriculum on the MOLST form reported barriers to using a mandated form despite receiving training. On-line modules may be insufficient for teaching communication skills to housestaff. Additional training opportunities including in-person training mechanisms should be incorporated into housestaff communication skills training related to end of life care.

Barriers to bystander CPR in deprived communities: Findings from a qualitative study.

STUDY AIM: Rates of out of hospital cardiac arrest are higher in deprived communities. Bystander Cardiopulmonary Resuscitation (BCPR) can double the chance of survival but occurs less often in these communities in comparison to more affluent communities. People living in deprived communities are, therefore, doubly disadvantaged and there is limited evidence to explain why BCPR rates are lower. The aim of this paper is to examine the barriers to administering BCPR in deprived communities. METHOD: Mixed method qualitative study with ten single sex focus groups (n = 61) conducted in deprived communities across central Scotland and 18 semi-structured interviews with stakeholders from the UK, Europe and the USA. RESULTS: Two key themes related to confidence and environmental factors were identified to summarise the perceived barriers to administering BCPR in deprived communities. Barriers related to confidence included: self-efficacy; knowledge and awareness of how, and when, to administer CPR; accessing CPR training; having previous experience of administering BCPR; who required CPR; and whether the bystander was physically fit to give CPR. Environmental barriers focused on the safety of the physical environment in which people lived, and fear of reprisal from gangs or the police. CONCLUSIONS: Barriers to administering BCPR identified in the general population are relevant to people living in deprived communities but are exacerbated by a range of contextual, individual and environmental factors. A one-size-fits-all approach is not sufficient to promote 'CPR readiness' in deprived communities. Future approaches to working with disadvantaged communities should be tailored to the local community.

Association of self-esteem, personality, stress and gender with performance of a resuscitation team: A simulation-based study.

BACKGROUND: Gender composition, stress and leadership of a resuscitation team influence CPR performance. Whether psychological variables such as self-esteem, motivation and personality traits are associated with resuscitation performance, stress levels and gender of rescuers during a cardiac arrest scenario remains uncertain. METHODS: We included 108 medical students in this prospective, observational simulator study. We videotaped the resuscitation performance and assessed self-esteem, perceived stress-overload and personality traits using validated questionnaires. In addition, we analysed leadership utterances and ECG data of all participants during the simulation. The primary endpoint was cardiopulmonary resuscitation performance, defined as hands-on time within the first 180 sec. Secondary outcomes included first meaningful measure of resuscitation, leadership statements of group leaders and physiological stress parameters of rescuers. RESULTS: Adjusted for group size and leadership designation, mean self-esteem of students was significantly associated with hands-on time (adjusted regression coefficient 7.94 (95%CI 2.61 to 13.27), p<0.01). The personality trait conscientiousness was positively associated with hands-on time (adjusted regression coefficient 38.4, [95%CI 7.41 to 69.38, p = 0.02]). However, after additional adjustment for self-esteem, this association was no longer significant. Further, agreeableness of team leaders was significantly associated with longer hands-on time (adjusted regression coefficient 20.87 [95%CI 3.81 to 37.94], p = 0.02). Openness to experience was negatively associated with heart rate reactivity (-5.92 (95%CI -10 to -1.85), p<0.01). Male students showed significantly higher (mean, [±SD]) self-esteem levels (24.6 [±3.8] vs. 22.0 [±4.4], p<0.01), expressed significantly more leadership statements (7.9 [±7.8] vs. 4.6 [±3.8], p<0.01) and initiated first resuscitation measures more often (n, [%]) compared to female students (16, [23] vs. 7, [12], p = 0.01). CONCLUSION: This simulator study found that self-esteem of resuscitation teams and agreeableness of team leaders of inexperienced students was associated with cardiopulmonary resuscitation performance. Whether enhancing these factors during resuscitation trainings serve for better performance remains to be studied.