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In-hospital cardiac arrest and cardiopulmonary resuscitation in Sweden: Healthcare professionals’ competence and compliance with guidelines
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
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 [en]
In-hospital cardiac arrest, Cardiopulmonary resuscitation, Clinical competence, Guideline adherence, Health personnel, Registries, Hospital units
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
URN: urn:nbn:se:du-47925ISBN: 978-91-88679-60-4 (print)OAI: oai:DiVA.org:du-47925DiVA, id: diva2:1831727
Public defence
lecture hall F135, campus Falun, and online (Swedish)
Opponent
Supervisors
Note

Ursprungligt datum för disputation 2024-05-24 inställt på grund av sjukdom. Inväntar nytt datum.

Available from: 2024-04-19 Created: 2024-01-26 Last updated: 2024-05-23Bibliographically approved
List of papers
1. Theoretical knowledge and self-assessed ability to perform cardiopulmonary resuscitation: a survey among 3044 healthcare professionals in Sweden
Open this publication in new window or tab >>Theoretical knowledge and self-assessed ability to perform cardiopulmonary resuscitation: a survey among 3044 healthcare professionals in Sweden
Show others...
2020 (English)In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 27, no 5, p. 368-372Article in journal (Refereed) Published
Abstract [en]

Objective Theoretical knowledge and ability to perform cardiopulmonary resuscitation (CPR) are unknown with regard to provided training. The aim of this study was to evaluate in-hospital healthcare professionals’ (HCPs) theoretical knowledge of CPR and their self-assessed ability to perform CPR and also to assess possible affecting factors. Method A questionnaire was sent to n = 5323 HCPs containing a nine-question knowledge test and a Likert scale measuring self-assessed ability. A factor score of self-assessed ability and a ratio scale of correct answers were dependent variables in multiple linear regression. Results Only 41% of the responding HCPs passed the knowledge test with seven or more correct answers. Nurses had the highest pass rate (50%) and the highest attendance rate at CPR training (56%). The ability to perform defibrillation was strongly agreed by 43% and the ability of leadership by only 7%. Working on a monitored ward, CPR training 0–6 months ago and being a nurse or physician were factors associated with more correct answers and higher ratings of abilities. Conclusion The overall theoretical knowledge was poor and ratings of self-assessed abilities to perform CPR were low. Working on a monitored ward, recently attended CPR training and being a nurse or physician were factors associated with higher theoretical knowledge and higher ratings of self-assessed ability to perform CPR. These findings imply prioritisation of CPR training.

Keywords
automated external defibrillators, cardiac arrest, cardiopulmonary resuscitation, emergency medicine
National Category
Clinical Medicine Health Sciences
Research subject
Research Profiles 2009-2020, Health and Welfare; Research Profiles 2009-2020, Health and Welfare
Identifiers
urn:nbn:se:du-34875 (URN)10.1097/MEJ.0000000000000692 (DOI)000567502300016 ()2-s2.0-85090003689 (Scopus ID)
Available from: 2020-08-26 Created: 2020-08-26 Last updated: 2024-04-19
2. Attitudes towards cardiopulmonary resuscitation situations and associations with potential influencing factors: A survey among in-hospital healthcare professionals
Open this publication in new window or tab >>Attitudes towards cardiopulmonary resuscitation situations and associations with potential influencing factors: A survey among in-hospital healthcare professionals
2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 7, article id e0271686Article in journal (Refereed) Published
Abstract [en]

Introduction Attitudes towards cardiopulmonary resuscitation (CPR) among in-hospital healthcare professionals (HCPs) are poorly understood. The aim of this study was to evaluate attitudes towards CPR situations among in-hospital HCPs and assess associations with potential influencing factors. Materials and methods A questionnaire was distributed to 3,085 HCPs in 2009 and 2,970 HCPs in 2015–2016. The associations of influencing factors were analyzed using binary logistic regression. Results In the event of a possible cardiac arrest situation, 61% of the HCPs would feel confident in their CPR knowledge, 86% would know what to do, and 60% would be able to take command if necessary. In the latest real-life CPR situation, 30% had been worried about making mistakes or causing complications, 57% had been stressed, and 27% had been anxious. A short time since the latest real-life CPR performance and a high number of previous real-life CPR performances were associated with lower odds of worrying about making mistakes/causing complications, lower odds of feeling stressed or anxious, and higher odds of feeling calm. Regardless of previous real-life CPR experience, there were differences in attitudes between groups of professions, where physicians showed increased odds of worrying about making mistakes/causing complications and nurses showed increased odds of stress. Working on a non-monitored ward meant increased odds of stress and worrying about making mistakes/causing complications. Twelve months or more having passed since the latest CPR training course was associated with increased odds of anxiety. Conclusions Despite HCPs’ generally positive attitudes towards performing CPR in the event of a possible cardiac arrest situation, feelings of stress and anxiety were common in real-life CPR situations. Regular CPR training among all HCPs is a key factor to maintain competence and reduce anxiety. The possible effects of attitudes on performing CPR need to be studied further.

National Category
Health Sciences
Identifiers
urn:nbn:se:du-42030 (URN)10.1371/journal.pone.0271686 (DOI)000944166200044 ()35839233 (PubMedID)2-s2.0-85134303533 (Scopus ID)
Available from: 2022-08-04 Created: 2022-08-04 Last updated: 2024-04-19Bibliographically approved
3. Incidence and case ascertainment of treated in-hospital cardiac arrest events in a national quality registry – a comparison of reported and non-reported events
Open this publication in new window or tab >>Incidence and case ascertainment of treated in-hospital cardiac arrest events in a national quality registry – a comparison of reported and non-reported events
2024 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 195, article id 110119Article in journal (Refereed) Published
Abstract [en]

Background: Approximately 2,500 in-hospital cardiac arrest (IHCA) events are reported annually to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) with an estimated incidence of 1.7/1,000 hospital admissions. The aim of this study was to evaluate the compliance in reporting IHCA events to the SRCR and to compare reported IHCA events with possible non-reported events, and to estimate IHCA incidence.

Methods: Fifteen diagnose codes, eight Classification of Care Measure codes, and two perioperative complication codes were used to find all treated IHCAs in 2018-2019 at six hospitals of varying sizes and resources. All identified IHCA events were cross-checked against the SRCR using personal identity numbers. All non-reported IHCA events were retrospectively reported and compared with the prospectively reported events.

Results: A total of 3,638 hospital medical records were reviewed and 1,109 IHCA events in 999 patients were identified, with 254 of the events not found in the SRCR. The case completeness was 77% (range 55-94%). IHCA incidence was 2.9/1,000 hospital admissions and 12.4/1,000 admissions to intensive care units. The retrospectively reported events were more often found on monitored wards, involved patients who were younger, had less comorbidity, were often found in shockable rhythm and more often achieved sustained spontaneous circulation, compared with in prospectively reported events.

Conclusion: IHCA case completeness in the SRCR was 77% and IHCA incidence was 2.9/1,000 hospital admissions. The retrospectively reported IHCA events were found in monitored areas where the rapid response team was not alerted, which might have affected regular reporting procedures.

Keywords
cardiac arrest; cardiopulmonary resuscitation; do not resuscitate order; hospitals; incidence; registries
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:du-47889 (URN)10.1016/j.resuscitation.2024.110119 (DOI)001179932200001 ()38244762 (PubMedID)2-s2.0-85184015947 (Scopus ID)
Available from: 2024-01-19 Created: 2024-01-19 Last updated: 2024-04-19Bibliographically approved
4. Compliance with cardiopulmonary resuscitation guidelines in witnessed in-hospital cardiac arrest events and patient outcome on monitored versus non-monitored wards
Open this publication in new window or tab >>Compliance with cardiopulmonary resuscitation guidelines in witnessed in-hospital cardiac arrest events and patient outcome on monitored versus non-monitored wards
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.

Keywords
compliance, in-hospital cardiac arrest, monitored areas, resuscitation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:du-47962 (URN)10.1016/j.resuscitation.2024.110125 (DOI)001181659900001 ()38272386 (PubMedID)2-s2.0-85183987359 (Scopus ID)
Available from: 2024-02-01 Created: 2024-02-01 Last updated: 2024-04-19Bibliographically approved

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