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MET actions at the scene and outcome
Abstracts / Resuscitation 96S (2015) 43–157
AP084 Do not attempt cardiopulmonary resuscitation (DNACPR) decisions: Clinical experiences and ethical considerations Claire Hawkes ∗ , Frances Griffiths, Anne-Marie Slowther, Sue Chambers, Gavin Perkins University of Warwick, Coventry, UK Purpose of the study: The purpose of this study was to understand UK acute and community National Health Service (NHS) health professionals’ experiences of DNACPR decision-making, its process and ethical challenges. Materials and methods: Multiple, brief focus groups explored health professionals’ perspectives drawing on pre-prepared vignettes, developed by the team, with some based on cases reported by NCEPOD in A Time to Interviene.1 An inductive thematic analysis identified decision-making process themes. Ethical issues and values identified in the analysis were considered in relation to ethical, professional and legal normative frameworks. Results: Two hundred and twenty three clinicians (doctors, nurses and paramedics) participated in 34 focus groups representing acute medicine, critical care, emergency medicine, geriatrics, palliative care, general practice, cardiology and surgery. Clinicians felt DNACPR decisions should be considered within the overall care of individual patients. Decisions were complex, involving staff patients and their families, with variation in local decision making processes and uncertainty for some about the legal framework. Some clinicians avoid raising discussions about CPR for fear of it generating conflict or complaint. Clinicians felt challenged by the need to balance conflicting ethical duties in situations of clinical uncertainty and time constraint. A key theme was the concern regarding negative impact on overall patient care of having a DNACPR decision and the conflation of ‘do not resuscitate’ with ‘do not provide active treatment’. Conclusions: DNACPR decisions are a normal part of clinical practice but they are complex, context specific and ethically challenging. They should be seen as one aspect of the holistic care of an individual. Clarification of the relationship between DNACPR decisions and other aspects of treatment and care is needed. A national policy embedding DNACPR decisions in emergency care and treatment plans would provide the necessary clarity and a framework for making these decisions.
Reference 1. Findlay, et al. Time to intervene? A review of patients who underwent cardiopulmonary resuscitation as a result of an in-hospital cardiorespiratory arrest. A report by the National Confidential Enquiry into Patient Outcome and Death.; 2012. http://www.ncepod.org.uk/2012report1/downloads/ CAP fullreport.pdf [accessed 12.06.15].
http://dx.doi.org/10.1016/j.resuscitation.2015.09.181 AP085 MET actions at the scene and outcome Raquel Silva ∗ , Manuel Saraiva, Teresa Cardoso, Irene Aragão Centro Hospitalar Do Porto, Porto, Portugal Purpose of the study: To analyze medical emergency team (MET) actions at the scene and the immediate and hospital outcomes.
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Materials and methods: Retrospective cohort study, at a university-affiliated tertiary care 600-bed hospital, from January 2012 to December 2013. The MET is composed by an intensive care nurse and doctor that respond immediately to call. Results: There were 511 MET activations: 389 (76%) were for inpatients and the remaining for outpatients. MET activations rate was 8.6/1000 inpatients. The group of 389 inpatients for whom MET was activated, had a mean (±SD) age of 72 (±11) years, 224 (58%) were male and 207 (53%) were medical patients. The main criteria for MET activation were airway threatening in 143 (36.8%), concern of clinical staff in 121 (31.1%) and decrease in GCS > 2 in 98 (25.2%); MET calls for cardiac arrest occurred in 68 patients (17.5%). The median (IQR) time the team stayed at the scene was 35 (20–50) min. During that time the most frequent actions were related with airway and ventilation, namely oxygen administration in 145 (37.3%) and ventilation in 90 (23.2%); in circulation, placement of venous access in 116 (29.8%) and fluid administration in 158 (40.6%); in 185 (47.5%) patients medications were administered. There were 20 calls (5.1%) for patients that had already an end-of-life decisions, 94 (24.1%) additional end-of-life decisions were placed by the MET. Mortality rate at the end of MET action was 19% (n = 73) and hospital mortality rate was 52,8% (n = 204). Conclusions: MET actions at the scene were “simple”, nevertheless nearly half of the patients required medications and rapid medical decisions. MET played an important role in multidisciplinary end of life decisions, relevant for the prevention of futile and sometimes harmful clinical options. These reinforce the activity and maintenance of ICU-MET team. http://dx.doi.org/10.1016/j.resuscitation.2015.09.182 AP086 Bystander resuscitation rate increased more than six times between 2003 and 2013 in the City of Prague Ondrej Franek ∗ , Pohlova Michaela, Sukupova Petra EMS City of Prague, Prague, Czech Republic Purpose of the study: Since 1.1.2003, systematic approach to dispatcher-assisted resuscitation (D-CPR) was introduced in Prague emergency medical dispatch centre. During following years great improvement of dispatcher skills and knowledge of cardiac arrest management was achieved. Following that, also a lot of public promotion effort took place (printed and social media promotion of bystander CPR, placing of “bystander-CPR promoting stickers” to all public transport vehicles in Prague, etc.). The aim of this study is to evaluate bystander resuscitation (B-CPR) rates in pre-hospital cardiac arrest in period from 1.1.2003 to 31.12.2013. Materials and methods: This is the retrospective analysis of data stored at Prague pre-hospital CPR registry. This registry contains data about all pre-hospital CPR in Prague, regardless age, nature of cardiac arrest etc. Patients unconscious during the first emergency call and resuscitated later by EMS crew were included in the study. Results: There were 5650 CPRs during last 11 years (incidence of 43 pre-hospital CPR per 100,000 inhabitants and year). The incidence had increasing tendency during study period (from 35.4 in 2003 to maximum of 50.0 in 2012). 4529 cases fulfilled inclusion criteria. From those patients, 2624 received B-CPR (58%). The rate of B-CPR dramatically increased during study period from 13.1% (395 cases included; 52 B-CPR) in 2003 to 81.6% (457 cases included; 373 B-CPR) in 2013 (p < 0.001).
AP084 Do not attempt cardiopulmonary resuscitation (DNACPR) decisions: Clinical experiences and ethical considerations Claire Hawkes ∗ , Frances Griffiths, Anne-Marie Slowther, Sue Chambers, Gavin Perkins University of Warwick, Coventry, UK Purpose of the study: The purpose of this study was to understand UK acute and community National Health Service (NHS) health professionals’ experiences of DNACPR decision-making, its process and ethical challenges. Materials and methods: Multiple, brief focus groups explored health professionals’ perspectives drawing on pre-prepared vignettes, developed by the team, with some based on cases reported by NCEPOD in A Time to Interviene.1 An inductive thematic analysis identified decision-making process themes. Ethical issues and values identified in the analysis were considered in relation to ethical, professional and legal normative frameworks. Results: Two hundred and twenty three clinicians (doctors, nurses and paramedics) participated in 34 focus groups representing acute medicine, critical care, emergency medicine, geriatrics, palliative care, general practice, cardiology and surgery. Clinicians felt DNACPR decisions should be considered within the overall care of individual patients. Decisions were complex, involving staff patients and their families, with variation in local decision making processes and uncertainty for some about the legal framework. Some clinicians avoid raising discussions about CPR for fear of it generating conflict or complaint. Clinicians felt challenged by the need to balance conflicting ethical duties in situations of clinical uncertainty and time constraint. A key theme was the concern regarding negative impact on overall patient care of having a DNACPR decision and the conflation of ‘do not resuscitate’ with ‘do not provide active treatment’. Conclusions: DNACPR decisions are a normal part of clinical practice but they are complex, context specific and ethically challenging. They should be seen as one aspect of the holistic care of an individual. Clarification of the relationship between DNACPR decisions and other aspects of treatment and care is needed. A national policy embedding DNACPR decisions in emergency care and treatment plans would provide the necessary clarity and a framework for making these decisions.
Reference 1. Findlay, et al. Time to intervene? A review of patients who underwent cardiopulmonary resuscitation as a result of an in-hospital cardiorespiratory arrest. A report by the National Confidential Enquiry into Patient Outcome and Death.; 2012. http://www.ncepod.org.uk/2012report1/downloads/ CAP fullreport.pdf [accessed 12.06.15].
http://dx.doi.org/10.1016/j.resuscitation.2015.09.181 AP085 MET actions at the scene and outcome Raquel Silva ∗ , Manuel Saraiva, Teresa Cardoso, Irene Aragão Centro Hospitalar Do Porto, Porto, Portugal Purpose of the study: To analyze medical emergency team (MET) actions at the scene and the immediate and hospital outcomes.
77
Materials and methods: Retrospective cohort study, at a university-affiliated tertiary care 600-bed hospital, from January 2012 to December 2013. The MET is composed by an intensive care nurse and doctor that respond immediately to call. Results: There were 511 MET activations: 389 (76%) were for inpatients and the remaining for outpatients. MET activations rate was 8.6/1000 inpatients. The group of 389 inpatients for whom MET was activated, had a mean (±SD) age of 72 (±11) years, 224 (58%) were male and 207 (53%) were medical patients. The main criteria for MET activation were airway threatening in 143 (36.8%), concern of clinical staff in 121 (31.1%) and decrease in GCS > 2 in 98 (25.2%); MET calls for cardiac arrest occurred in 68 patients (17.5%). The median (IQR) time the team stayed at the scene was 35 (20–50) min. During that time the most frequent actions were related with airway and ventilation, namely oxygen administration in 145 (37.3%) and ventilation in 90 (23.2%); in circulation, placement of venous access in 116 (29.8%) and fluid administration in 158 (40.6%); in 185 (47.5%) patients medications were administered. There were 20 calls (5.1%) for patients that had already an end-of-life decisions, 94 (24.1%) additional end-of-life decisions were placed by the MET. Mortality rate at the end of MET action was 19% (n = 73) and hospital mortality rate was 52,8% (n = 204). Conclusions: MET actions at the scene were “simple”, nevertheless nearly half of the patients required medications and rapid medical decisions. MET played an important role in multidisciplinary end of life decisions, relevant for the prevention of futile and sometimes harmful clinical options. These reinforce the activity and maintenance of ICU-MET team. http://dx.doi.org/10.1016/j.resuscitation.2015.09.182 AP086 Bystander resuscitation rate increased more than six times between 2003 and 2013 in the City of Prague Ondrej Franek ∗ , Pohlova Michaela, Sukupova Petra EMS City of Prague, Prague, Czech Republic Purpose of the study: Since 1.1.2003, systematic approach to dispatcher-assisted resuscitation (D-CPR) was introduced in Prague emergency medical dispatch centre. During following years great improvement of dispatcher skills and knowledge of cardiac arrest management was achieved. Following that, also a lot of public promotion effort took place (printed and social media promotion of bystander CPR, placing of “bystander-CPR promoting stickers” to all public transport vehicles in Prague, etc.). The aim of this study is to evaluate bystander resuscitation (B-CPR) rates in pre-hospital cardiac arrest in period from 1.1.2003 to 31.12.2013. Materials and methods: This is the retrospective analysis of data stored at Prague pre-hospital CPR registry. This registry contains data about all pre-hospital CPR in Prague, regardless age, nature of cardiac arrest etc. Patients unconscious during the first emergency call and resuscitated later by EMS crew were included in the study. Results: There were 5650 CPRs during last 11 years (incidence of 43 pre-hospital CPR per 100,000 inhabitants and year). The incidence had increasing tendency during study period (from 35.4 in 2003 to maximum of 50.0 in 2012). 4529 cases fulfilled inclusion criteria. From those patients, 2624 received B-CPR (58%). The rate of B-CPR dramatically increased during study period from 13.1% (395 cases included; 52 B-CPR) in 2003 to 81.6% (457 cases included; 373 B-CPR) in 2013 (p < 0.001).