Determinants of physician reluctance to perform mouth-to-mouth resuscitation

Cross-sectional survey of Good Samaritan behaviour by physicians in North Carolina

OBJECTIVE

To assess the responses of physicians to providing emergency medical assistance outside of routine clinical care. We assessed the percentage who reported previous Good Samaritan behaviour, their responses to hypothetical situations, their comfort providing specific interventions and the most likely reason they would not intervene.

SETTING

Physicians residing in North Carolina.

PARTICIPANTS

Convenience sample of 1000 licensed physicians.

INTERVENTION

Mailed survey.

DESIGN

Cross-sectional study conducted May 2015 to September 2015.

MAIN OUTCOME AND MEASURES

Willingness of physicians to act as Good Samaritans as determined by the last opportunity to intervene in an out-of-office emergency.

RESULTS

The adjusted response rate was 26.1% (253/970 delivered). 4 out of 5 physicians reported previous opportunities to act as Good Samaritans. Approximately, 93% reported acting as a Good Samaritan during their last opportunity. There were no differences in this outcome between sexes, practice setting, specialty type or experience level. Doctors with greater perceived knowledge of Good Samaritan law were more likely to have intervened during a recent opportunity (p=0.02). The most commonly cited reason for potentially not intervening was that another health provider had taken charge.

CONCLUSIONS

We found the frequency of Good Samaritan behaviour among physicians to be much higher than reported in previous studies. Greater helping behaviour was exhibited by those who expressed more familiarity with Good Samaritan law. These findings suggest that physicians may respond to legal protections.

Ethical and practical considerations in providing critical care to patients with Ebola virus disease

Infectious disease epidemics in the past have given rise to psychologic and emotional responses among health-care workers (HCWs), stemming from fear of infection during patient care. Early experiences in the AIDS epidemic provide an example where fear of contagion resulted in differential treatment of patients infected with HIV. However, with a deeper understanding of AIDS pathogenesis and treatment, fear and discrimination diminished. Parallels exist between early experiences with AIDS and the present outbreak of Ebola virus disease in West Africa, particularly regarding discussions of medical futility in seriously ill patients. We provide a historical perspective on HCWs' risk of infection during the provision of CPR, discuss physicians' duty to treat in the face of perceived or actual HCW risk, and, finally, present the protocols implemented at the National Institutes of Health to reduce HCW risk while providing lifesaving and life-sustaining care.

Cardiopulmonary resuscitation, chest compression only and teamwork from the perspective of medical doctors, surgeons and anesthesiologists

Background:

New resuscitation guidelines that were proposed by the European Resuscitation Council in 2010 have introduced a new method of cardiopulmonary resuscitation (CPR) by chest compressions only for untrained individuals.

Objectives:

We conducted this study to evaluate differences in attitudes towards CPR among medical doctors, surgeons and anesthesiologists in Osijek University Hospital. A call for help, chest-compression-only resuscitation, mouth-to-mouth ventilation and team-work were recognized as critical points that may influence the outcome. Unfamiliarity with these methods may be indicative of a lack of education in resuscitation and may result in poor outcomes for victims.

Patients and Methods:

An anonymous survey was conducted on 190 medical professionals: 93 medical doctors, 70 surgeons, and 27 anesthesiologists during year 2012 (mean age 41.9 years). The questions were related to previous education in resuscitation, current resuscitation practices and attitudes towards cardiopulmonary resuscitation. Data were analyzed using ANOVA and Fisher exact test. A P value of < 0.05 was considered statistically significant.

Results:

The only difference between groups was regarding the male and female ratio, with more male surgeons (45, 55, and 11, P < 0.001). All doctors considered CPR as important, but only anesthesiologists knew how often guidelines in CPR change. Approximately 45% of medical doctors, 48% of surgeons and 77% of anesthesiologists reported that they have renewed their knowledge in CPR within the last five years, whereas 34%, 25% and 22% had never renewed their knowledge in the CPR (P = 0.01 between surgeons anesthesiologists). Furthermore, chest-compression-only was recognized as a valuable CPR technique by 25.8% of medical doctors, 14.3% of surgeons and 59.3% of anesthesiologists (P < 0.001). Anesthesiologists estimated a high risk of infection transmission (62%) and were more likely to refuse mouth-to-mouth ventilation when compared to surgeons (25% vs.10%, P = 0.01). Anesthesiologists are most often called for help by their colleagues, only rarely surgeons call their departmental colleagues and nurses to help in CPR.

Conclusions:

An insufficient formal education in CPR was registered for all groups, reflecting the lack of familiarity with new CPR methods. A team education, involving doctors and nurses may improve familiarity with CPR and patient outcomes.

Knowledge and attitudes towards cardiopulmonary resuscitation and defibrillation amongst Asian primary health care physicians

Objective

To assess the knowledge and attitudes of local primary health care physicians in relation to cardiopulmonary resuscitation (CPR) and defibrillation.

Methods

We conducted a survey on general practitioners in Singapore by using a self-administered questionnaire that comprised 29 questions.

Results

The response rate was 80%, with 60 of 75 physicians completing the questionnaire. The average age of the respondents was 52 years. Sixty percent of them reported that they knew how to operate an automated external defibrillator (AED), and 38% had attended AED training. Only 36% were willing to perform mouth-to-mouth ventilation during CPR, and 53% preferred chest compression-only resuscitation (CCR) to standard CPR. We found those aged <50 years were more likely to be trained in basic cardiac life support (BCLS) (P < 0.001) and advanced cardiac life support (P = 0.005) or to have ever attended to a patient with cardiac arrest (P = 0.007). Female physicians tended to agree that all clinics should have AEDs (P = 0.005) and support legislation to make AEDs compulsory in clinics (P < 0.001). We also found that a large proportion of physicians who were trained in BCLS (P = 0.006) were willing to perform mouth-to-mouth ventilation.

Conclusion

Most local primary care physicians realize the importance of defibrillation, and the majority prefer CCR to standard CPR.

Comparison of chest compression only and standard cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Singapore

OBJECTIVE

Chest compression only cardiopulmonary resuscitation (CC-CPR) without ventilation has been proposed as an alternative to standard cardiopulmonary resuscitation (CPR) for bystanders. However, there has been controversy regarding the relative effectiveness of both of these techniques. We aim to compare the outcomes of cardiac arrest patients in the cardiac arrest and resuscitation epidemiology study who either received CC-CPR, standard CPR or no bystander CPR.

METHODS

This prospective cohort study involved all out-of-hospital cardiac arrest (OHCA) patients attended to by emergency medical service (EMS) providers in a large urban centre. The data analyses were conducted secondarily on these collected data. The technique of bystander CPR was reported by paramedics who arrived at the scene.

RESULTS

From 1 October 2001 to 14 October 2004, 2428 patients were enrolled into the study. Of these, 255 were EMS-witnessed arrests and were excluded. 1695 cases did not receive any bystander CPR, 287 had standard CPR and 154 CC-CPR. Patient characteristics were similar in both the standard and CC-CPR groups except for a higher incidence of residential arrests and previous heart disease sufferers in the CC-CPR group. Patients who received standard CPR (odds ratio (OR) 5.4, 95% confidence interval (CI) 2.1-14.0) or CC-CPR (OR 5.0, 95% CI 1.5-16.4) were more likely to survive to discharge than those who had no bystander CPR. There was no significant difference in survival to discharge between those who received CC-CPR and standard CPR (OR 0.9, 95% CI 0.3-3.1).

CONCLUSION

We found that patients were more likely to survive with any form of bystander CPR than without. This emphasises the importance of chest compressions for OHCA patients, whether with or without ventilation.

Emergency department evaluations of non-percutaneous blood or body fluid exposures during cardiopulmonary resuscitation

INTRODUCTION

The demography of healthcare workers (HCWs) and non-HCWs seeking medical care at emergency departments after a non-percutaneous potential exposure to human immunodeficiency virus (HIV) during cardiopulmonary resuscitation (CPR), the types and body locations of their exposures, the time elapsed from exposure to emergency department presentation, and usage of HIV-post-exposure prophylaxis (PEP) for these exposures are described.

METHODS

A retrospective study of emergency department patients who were exposed to blood or body fluids during CPR in Rhode Island from January 1995-June 2001 was performed. The demography, characteristics of the exposure, and HIV-PEP usage for these patients were compared, and the elapsed time from exposure to evaluation in the emergency department was calculated.

RESULTS

Of the 39 patients exposed to non-percutaneous blood or body fluid during CPR, 22 were healthcare workers (HCWs) and 17 were non-HCWs. Thirty-four patients sustained mucous membrane exposures. Most of the patients (69.2%) were exposed to saliva or sputum (p <0.001), experienced a mouth exposure (71.8%; p <0.0001) and presented to the emergency department within one day of their exposure (84.4%; p <0.0001). Three HCWs and no non-HCWs were offered HIV-PEP for their CPR exposure. Of the three HCWs offered PEP, two actually received it.

CONCLUSIONS

Nearly half of the patients who presented with non-percutaneous exposures acquired during CPR were not HCWs. Most of the exposures were to saliva or sputum and occurred on their mucous membranes. Continuing education programs on maintaining universal precautions to prevent blood or body fluid exposures and appreciating the benign nature of most non-percutaneous exposures possible during CPR are needed.

Compression-only cardiopulmonary resuscitation for bystanders and first responders

PURPOSE OF REVIEW

The current resuscitation guidelines consider ventilation and chest compression essential components of resuscitation and therefore only one methodology, standard cardiopulmonary resuscitation, is explicitly recommended for the treatment of both respiratory and cardiac arrests. Pathophysiological and experimental observations argue that this generalization results in suboptimal treatment for victims of cardiac arrest.

RECENT FINDINGS

For more than a decade animal studies have demonstrated that assisted ventilation is not essential during the initial treatment of a fibrillatory arrest; but only in the last year have these results been confirmed in humans. These new observations come from a handful of systems utilizing cardiocerebral resuscitation in their prehospital resuscitation of adult victims of presumed cardiac arrest. They have all demonstrated a dramatic increase in survival. Recent data also indicate that survival is significantly increased when laypersons perform chest-compression-only cardiopulmonary resuscitation.

SUMMARY

The current resuscitation guidelines regarding the prehospital treatment of victims of adult cardiac arrest should be modified to explicitly permit the use of continuous-chest-compression cardiopulmonary resuscitation.

Effectiveness of mouth-to-mouth resuscitation performed by young adolescents on a mannequin

Bystanders are reluctant to perform basic life support (BLS) because of fear of failure and of infection, especially with mouth-to-mouth resuscitation (MTM). A possibility to enhance willingness could be the giving of MTM or BLS instructions at a very early age to the potential rescuers. The study aimed to investigate the effectiveness of MTM with respect to ventilation and the time needed for performing 5 ventilations. In this study, MTM was performed on a mannequin by 57 children and adolescents aged 10 and 14 years. This study showed that 14-year-olds effectively perform MTM, reaching the recommended tidal volumes. Ten-year-old children have already developed sufficient motor skills for MTM with no significant time differences compared with the 14-year-olds. However, physical demands may be rather high at this age. Further long-term studies are needed to investigate clinical benefits of early teaching of MTM or BLS that may lead to international guidelines with low age limits.

["Topless" cardiopulmonary resuscitation. Fashion or science?]

A decade after the onset of a discussion whether ventilation could be omitted from bystander basic life support (BLS) algorithms, the state of the evidence is reevaluated. Initial animal studies and a prospective randomized patient trial had suggested that omission of ventilation during the first minutes of lay cardiopulmonary resuscitation (CPR) did not impair patient outcomes. More recent studies demonstrate, however, that this may hold true only in very specific scenarios, and that the chest compression-only technique was never superior to standard BLS. Instead of calling basics of BLS training and practice into question, more and better training of lay persons and professionals appears mandatory, and targeted use of dispatcher-guided telephone CPR should be evaluated and, if it improves outcome, it should be encouraged. Future studies should focus much less on the omission but on the optimization of ventilation under the specific conditions of CPR.