Sinnige JS, Kooij FO, van Schuppen H, Hollmann MW, Sperna Weiland NH.
No abstract available
Sinnige JS, Kooij FO, van Schuppen H, Hollmann MW, Sperna Weiland NH.
No abstract available
van Schuppen H, Boomars R, Kooij FO, den Tex P, Koster RW, Hollmann MW.
Airway management and ventilation are essential components of cardiopulmonary resuscitation to achieve oxygen delivery in order to prevent hypoxic injury and increase the chance of survival. Weighing the relative benefits and downsides, the best approach is a staged strategy; start with a focus on high-quality chest compressions and defibrillation, then optimize mask ventilation while preparing for advanced airway management with a supraglottic airway device. Endotracheal intubation can still be indicated, but has the largest downsides of all advanced airway techniques. Whichever stage of airway management, ventilation and chest compression quality should be closely monitored. Capnography has many advantages and should be used routinely. Optimizing ventilation strategies, harmonizing ventilation with mechanical chest compression devices, and implementation in complex and stressful environments are challenges we need to face through collaborative innovation, research, and implementation.
Keywords: airway management; capnography; cardiopulmonary resuscitation; out-of-hospital cardiac arrest; prehospital advanced life support; ventilation.
Dijkstra FS, Renden PG, Meeter M, Schoonmade LJ, Krage R, van Schuppen H, de
la Croix A.
Background: Teamwork is essential in healthcare, but team performance tends to deteriorate in stressful situations. Further development of training and education for healthcare teams requires a more complete understanding of team performance in stressful situations. We wanted to learn from others, by looking beyond the field of medicine, aiming to learn about a) sources of stress, b) effects of stress on team performance and c) concepts on dealing with stress.
Methods: A scoping literature review was undertaken. The three largest interdisciplinary databases outside of healthcare, Scopus, Web of Science and PsycINFO, were searched for articles published in English between 2008 and 2020. Eligible articles focused on team performance in stressful situations with outcome measures at a team level. Studies were selected, and data were extracted and analysed by at least two researchers.
Results: In total, 15 articles were included in the review (4 non-comparative, 6 multi- or mixed methods, 5 experimental studies). Three sources of stress were identified: performance pressure, role pressure and time pressure. Potential effects of stress on the team were: a narrow focus on task execution, unclear responsibilities within the team and diminished understanding of the situation. Communication, shared knowledge and situational awareness were identified as potentially helpful team processes. Cross training was suggested as a promising intervention to develop a shared mental model within a team.
Conclusion: Stress can have a significant impact on team performance. Developing strategies to prevent and manage stress and its impact has the potential to significantly increase performance of teams in stressful situations. Further research into the development and use of team cognition in stress in healthcare teams is needed, in order to be able to integrate this ‘team brain’ in training and education with the specific goal of preparing professionals for team performance in stressful situations.
Keywords: Crew resource management; Critical care; Emergency care; Human factors; Performance psychology; Stress; Team performance; Teams.
Druwé P, Monsieurs KG, Gagg J, Nakahara S, Cocchi MN, Élő G, van Schuppen H,
Alpert EA, Truhlář A, Huybrechts SA, Mpotos N, Paal P, BjØrshol C, Xanthos T,
Joly LM, Roessler M, Deasy C, Svavarsdóttir H, Nurmi J, Owczuk R, Salmeron PP,
Cimpoesu D, Fuenzalida PA, Raffay V, Steen J, Decruyenaere J, De Paepe P, Piers
R, Benoit DD; REAPPROPRIATE study group.
Introduction: Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians.
Methods: A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals.
Results: Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]).
Conclusion: Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.
Keywords: Emergency department; Emergency medical services; Futility; Inappropriate cardiopulmonary resuscitation; Moral distress; Out of hospital cardiac arrest.
Druwé P, Benoit DD, Monsieurs KG, Gagg J, Nakahara S, Alpert EA, van Schuppen
H, Élő G, Huybrechts SA, Mpotos N, Joly LM, Xanthos T, Roessler M, Paal P,
Cocchi MN, Bjørshol C, Nurmi J, Salmeron PP, Owczuk R, Svavarsdóttir H, Cimpoesu
D, Raffay V, Pachys G, De Paepe P, Piers R; REAPPROPRIATE study group.
Objectives: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out-of-hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome.
Design: Subanalysis of an international multicenter cross-sectional survey (REAPPROPRIATE).
Setting: Out-of-hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older.
Participants: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics.
Results and measurements: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non-shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non-shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate.
Conclusion: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39-45, 2019.
Keywords: adults 80 and older; cardiopulmonary resuscitation; inappropriate care; nursing homes; out-of-hospital cardiac arrest.
Pepe PE, Aufderheide TP, Lamhaut L, Davis DP, Lick CJ, Polderman KH, Scheppke
KA, Deakin CD, O’Neil BJ, van Schuppen H, Levy MK, Wayne MA, Youngquist ST,
Moore JC, Lurie KG, Bartos JA, Bachista KM, Jacobs MJ, Rojas-Salvador C, Grayson
ST, Manning JE, Kurz MC, Debaty G, Segal N, Antevy PM, Miramontes DA, Cheskes S,
Holley JE, Frascone RJ, Fowler RL, Yannopoulos D.
Objectives: To construct a highly detailed yet practical, attainable roadmap for enhancing the likelihood of neurologically intact survival following sudden cardiac arrest.
Design setting and patients: Population-based outcomes following out-of-hospital cardiac arrest were collated for 10 U.S. counties in Alaska, California, Florida, Ohio, Minnesota, Utah, and Washington. The 10 identified emergency medical services systems were those that had recently reported significant improvements in neurologically intact survival after introducing a more comprehensive approach involving citizens, hospitals, and evolving strategies for incorporating technology-based, highly choreographed care and training. Detailed inventories of in-common elements were collated from the ten 9-1-1 agencies and assimilated. For reference, combined averaged outcomes for out-of-hospital cardiac arrest occurring January 1, 2017, to February 28, 2018, were compared with concurrent U.S. outcomes reported by the well-established Cardiac Arrest Registry to Enhance Survival.
Interventions: Most commonly, interventions and components from the ten 9-1-1 systems consistently included extensive public cardiopulmonary resuscitation training, 9-1-1 system-connected smart phone applications, expedited dispatcher procedures, cardiopulmonary resuscitation quality monitoring, mechanical cardiopulmonary resuscitation, devices for enhancing negative intrathoracic pressure regulation, extracorporeal membrane oxygenation protocols, body temperature management procedures, rapid cardiac angiography, and intensive involvement of medical directors, operational and quality assurance officers, and training staff.
Measurements and main results: Compared with Cardiac Arrest Registry to Enhance Survival (n = 78,704), the cohorts from the 10 emergency medical services agencies examined (n = 2,911) demonstrated significantly increased likelihoods of return of spontaneous circulation (mean 37.4% vs 31.5%; p < 0.001) and neurologically favorable hospital discharge, particularly after witnessed collapses involving bystander cardiopulmonary resuscitation and shockable cardiac rhythms (mean 10.7% vs 8.4%; p < 0.001; and 41.6% vs 29.2%; p < 0.001, respectively).
Conclusions: The likelihood of neurologically favorable survival following out-of-hospital cardiac arrest can improve substantially in communities that conscientiously and meticulously introduce a well-sequenced, highly choreographed, system-wide portfolio of both traditional and nonconventional approaches to training, technologies, and physiologic management. The commonalities found in the analyzed systems create a compelling case that other communities can also improve out-of-hospital cardiac arrest outcomes significantly by conscientiously exploring and adopting similar bundles of system organization and care.
Keywords: bundle of care; cardiac arrest; cardiopulmonary resuscitation; emergency medical services; resuscitation centers; sudden cardiac death survival.
In February 2020 I was honored to give a presentation at The Big Sick conference in Zermatt, on citizen response in cardiac arrest. I feel that many of us, who are involved in cardiopulmonary resuscitation in the hospital setting, keep their focus limited to the emergency department. But the truth is that the biggest impact on survival is prompt recognition, call to the dispatch center, initiation of BLS and immediate use of a nearby AED. To achieve this, we need to train, equip and alert citizens to help optimize survival in out-of-hospital cardiac arrest. With this talk, I hope to inspire you to take action and achieve an optimal response in the very first minutes of out-of-hospital cardiac arrest in your region.
This conference was amazing and I really enjoyed spending time with so many resuscitationists, exchanging thoughts on resuscitation and ways how we might improve the care for our patients. Thanks to the organizing committee for the invitation!
All talks of TBS20 were recorded and put online on the website of ScanFOAM, which I highly recommend! #FOAMed
I was invited to give a talk on ‘The Prehospital Physician Controversy’ at Notfallmedizin 2018. This is the biannual congress on emergency medicine of the Arbeitsgemeinschaft für Notfallmedizin (AGN). This year it was held on April 6-7 in Graz, Austria. It was an awesome conference where a complete track was in English and broadcasted through their YouTube channel. So the spirit of FOAMed was alive and kicking. It was great to meet people whose research I have been reading and with whom I was in contact with through social media. The best part of these conferences is exchanging thoughts with fellow resuscitationists so I went home with lots of new ideas and inspiration to improve resuscitation and new friends to collaborate with. Thanks to AGN for recording the lectures so we are able to spread the learning. Special shout out to Simon Orlob, you have been a great host!
I hope you will find this lecture interesting and it will help you in improving prehospital care. Feel free to post a comment, I would love to hear your thoughts!
Resuscitation. 2018 Sep 12;132:112-119.
Druwé P, Monsieurs KG, Piers R, Gagg J, Nakahara S, Alpert EA, van Schuppen H, Élő G, Truhlář A, Huybrechts SA, Mpotos N, Joly LM, Xanthos T, Roessler M, Paal P, Cocchi MN, BjØrshol C, Pauliková M, Nurmi J, Salmeron PP, Owczuk R, Svavarsdóttir H, Deasy C, Cimpoesu D, Ioannides M, Fuenzalida PA, Kurland L, Raffay V, Pachys G, Gadeyne B, Steen J, Vansteelandt S, De Paepe P, Benoit DD.
Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome.
A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models.
Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician’s characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P < .0001), a non-witnessed arrest (2.68 [1.89-3.79]; P < .0001), in older patients (2.94 [2.18-3.96]; P < .0001, for patients >79 years) and in case of a “poor” first physical impression of the patient (3.45 [2.36-5.05]; P < .0001). In accordance, non-shockable and non-witnessed arrests were both associated with lower survival to hospital discharge (0.33 [0.26-0.41]; P < 0.0001 and 0.25 [0.15-0.41]; P < 0.0001, respectively), as were older patient age (0.25 [0.14-0.44]; P < 0.0001 for patients >79 years) and a “poor” first physical impression (0.26 [0.19-0.35]; P < 0.0001).
The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.
I was invited to give a talk on airway management and ventilation during cardiopulmonary resuscitation at Notfallmedizin 2018: ‘Ventilation in CPR: Don’t forget the flow – blood flow!’. This is the biannual congress on emergency medicine of the Arbeitsgemeinschaft für Notfallmedizin (AGN). This year it was held on April 6-7 in Graz, Austria. It was an awesome conference where a complete track was in English and broadcasted through their YouTube channel. So the spirit of FOAMed was alive and kicking. It was great to meet people whose research I have been reading and with whom I was in contact with through social media. The best part of these conferences is exchanging thoughts with fellow resuscitationists so I went home with lots of new ideas and inspiration to improve resuscitation and new friends to collaborate with. Thanks to AGN for recording the lectures so we are able to spread the learning. Special shout out to Simon Orlob, you have been a great host!
I hope you will find this lecture interesting and it will help you in your next cardiac arrest resuscitation. Feel free to post a comment, I would love to hear your thoughts!