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Compliance with cardiopulmonary resuscitation guidelines in witnessed in-hospital cardiac arrest events and patient outcome on monitored versus non-monitored wards
Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing.ORCID iD: 0000-0003-4787-5421
Dalarna University, School of Health and Welfare, Medical Science. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge; Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun.ORCID iD: 0000-0001-7767-4589
Dalarna University, School of Health and Welfare, Medical Science. Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun; Department of Prehospital Care, Region Dalarna, Falun.ORCID iD: 0000-0001-6885-991x
2024 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 196, article id 110125Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Adherence to cardiopulmonary resuscitation (CPR) guidelines in treatment of in-hospital cardiac arrest (IHCA) have been associated with favourable patient outcome. The aim of this study was to evaluate if compliance with initial CPR guidelines and patient outcome of witnessed IHCA events were associated with the place of arrest defined as monitored versus non-monitored ward.

METHODS: A total of 956 witnessed IHCA events in adult patients at six hospitals during 2018 to 2019, were extracted from the Swedish Registry of Cardiopulmonary Resuscitation. Initial CPR guidelines were: ≤ 1 min from collapse to alert of the rapid response team, ≤ 1 min from collapse to start of CPR, ≤ 3 min from collapse to defibrillation of shockable rhythm.

RESULTS: The odds of compliance with guidelines was higher on monitored wards vs non-monitored wards, even after adjustment for factors that could affect staffing and resources. The place of arrest was not a significant factor for sustained return of spontaneous circulation, survival at 30 days, or neurological status at discharge, when adjusting for clinically relevant confounders. Compliance with initial CPR guidelines remained a significant factor for survival to 30 days and favourable neurological outcome at discharge regardless of other confounders.

CONCLUSION: Compliance with initial CPR guidelines was higher in witnessed IHCA events on monitored wards than on non-monitored wards, which indicates that healthcare professionals in monitored wards are quicker to recognize a cardiac arrest and initiate treatment. When initial CPR guidelines are followed, the place of arrest does not influence patient outcome.

Place, publisher, year, edition, pages
2024. Vol. 196, article id 110125
Keywords [en]
compliance, in-hospital cardiac arrest, monitored areas, resuscitation
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:du-47962DOI: 10.1016/j.resuscitation.2024.110125ISI: 001181659900001PubMedID: 38272386Scopus ID: 2-s2.0-85183987359OAI: oai:DiVA.org:du-47962DiVA, id: diva2:1833703
Available from: 2024-02-01 Created: 2024-02-01 Last updated: 2024-04-19Bibliographically approved
In thesis
1. In-hospital cardiac arrest and cardiopulmonary resuscitation in Sweden: Healthcare professionals’ competence and compliance with guidelines
Open this publication in new window or tab >>In-hospital cardiac arrest and cardiopulmonary resuscitation in Sweden: Healthcare professionals’ competence and compliance with guidelines
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Competence in cardiopulmonary resuscitation (CPR) is the foundation for performing CPR in accordance with guidelines during in-hospital cardiac arrest (IHCA) events, which is crucial to patient survival. All IHCA events are to be reported to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR), but compliance is unclear. This may affect the interpretation of patient characteristics, IHCA care and outcomes.

The aim of this thesis was to evaluate CPR competence and compliance with guidelines among in-hospital healthcare professionals (HCP), including evaluation of possible associated factors, patient characteristics, situational factors, and patient outcomes in the in-hospital setting.

Methods: Data were collected through surveys among in-hospital HCPs during 2009 and 2013–2016. Further, data from the SRCR, the Swedish PeriOperative Register, and medical records were used to find all treated IHCA events at selected hospitals during 2018–2019. All witnessed IHCA events involving adult patients were evaluated regarding compliance with initial CPR guidelines.

Results: The theoretical knowledge of CPR was poor and self-assessed abilities of performing CPR were low. Recent CPR training, working on a monitored ward, and being a nurse or physician were factors associated with higher knowledge and ratings of abilities. A majority of HCPs showed positive attitudes towards being required to perform CPR. However, attitudes in real-life IHCA situations signaled a possible perceived lack of resources. The case completeness of IHCA events in the SRCR was lacking. Most non-reported events occurred on monitored wards, with differences from reported events observed. Compliance with initial CPR guidelines was higher among HCPs on monitored wards versus non-monitored wards, but the place of arrest was not associated with patient outcome.

Conclusion: The results underline the importance of frequent CPR training, especially on non-monitored wards, and of compliance with initial CPR guidelines. Non-reporting of IHCA events on monitored wards affects the interpretation of patient characteristics, IHCA care and outcomes. The procedures for reporting IHCA to the SRCR need to be well established. Reviews of patient medical records from monitored wards may improve case completeness in the SRCR.

Place, publisher, year, edition, pages
Falun: Dalarna University, 2024
Series
Dalarna Doctoral Dissertations ; 31
Keywords
In-hospital cardiac arrest, Cardiopulmonary resuscitation, Clinical competence, Guideline adherence, Health personnel, Registries, Hospital units
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:du-47925 (URN)978-91-88679-60-4 (ISBN)
Public defence
2024-06-11, lecture hall F134, campus Falun, and online, 13:00 (Swedish)
Opponent
Supervisors
Note

Ursprungligt datum för disputation 2024-05-24 ställdes in på grund av sjukdom. Nytt datum blev 2024-06-11, vilket anges i separat spikblad.

Available from: 2024-04-19 Created: 2024-01-26 Last updated: 2024-05-28Bibliographically approved

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Silverplats, JennieÄng, BjörnStrömsöe, Anneli

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