Decision making in prehospital traumatic cardiac arrest; A qualitative study

Leemeyer, Anna-Marie R.; Lieshout, Esther M.M. Van; Bouwens, Maneka; Breeman, Wim; Verhofstad, Michael H.J.; Vledder, Mark G. van

doi:10.1016/j.injury.2020.01.001

Cited by 15 publications

(25 citation statements)

References 15 publications

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“…We found that ethically relevant information primarily was related to the basic bioethical principles of autonomy and non-maleficence/beneficence. This finding is in line with previous research [ 4 , 6 , 11 , 38 , 39 ]. The assessment of the patients’ quality of life and the remaining length of life were predominant factors identified in this study.…”

Section: Discussionsupporting

confidence: 94%

“…Decision-making in prehospital resuscitation should ideally include both clinical and ethical considerations [ 9 ]. There is not much knowledge of the extent and quality of ethical considerations and their influence on resuscitation [ 10 , 11 ]. The European Resuscitation Council guidelines include the sub-category “Ethics of resuscitation and end of life decisions”.…”

Section: Introductionmentioning

confidence: 99%

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Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests

et al. 2021

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Background Decision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation. Methods This was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice. Results Of 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making. Conclusions There is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests

et al. 2021

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“…The included papers contained data from 25 unique studies. Of these papers, 12 were qualitative studies [ 5 , 8 , 22 – 31 ], two mixed-method studies [ 32 , 33 ], and 13 quantitative studies [ 34 – 46 ]. The papers were published between 1993 and 2021.…”

Section: Resultsmentioning

confidence: 99%

“…As the field of resuscitation evolves, the context in which healthcare professionals make decisions changes. Recent studies describe new aspects, including non-medical factors, in decision-making in prehospital resuscitation [ 5 – 9 ]. We aimed to review original studies on non-medical factors that pre-hospital care providers describe as important for decision-making in adult resuscitation..…”

Section: Introductionmentioning

confidence: 99%

Non-medical factors in prehospital resuscitation decision-making: a mixed-methods systematic review

Milling

Kjær

Binderup

et al. 2022

Scand J Trauma Resusc Emerg Med

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Aim This systematic review explored how non-medical factors influence the prehospital resuscitation providers’ decisions whether or not to resuscitate adult patients with cardiac arrest. Methods We conducted a mixed-methods systematic review with a narrative synthesis and searched for original quantitative, qualitative, and mixed-methods studies on non-medical factors influencing resuscitation of out-of-hospital cardiac arrest. Mixed-method reviews combine qualitative, quantitative, and mixed-method studies to answer complex multidisciplinary questions. Our inclusion criteria were peer-reviewed empirical-based studies concerning decision-making in prehospital resuscitation of adults > 18 years combined with non-medical factors. We excluded commentaries, case reports, editorials, and systematic reviews. After screening and full-text review, we undertook a sequential exploratory synthesis of the included studies, where qualitative data were synthesised first followed by a synthesis of the quantitative findings. Results We screened 15,693 studies, reviewed 163 full-text studies, and included 27 papers (12 qualitative, two mixed-method, and 13 quantitative papers). We identified five main themes and 13 subthemes related to decision-making in prehospital resuscitation. Especially the patient’s characteristics and the ethical aspects were included in decisions concerning resuscitation. The wishes and emotions of bystanders further influenced the decision-making. The prehospital resuscitation providers’ characteristics, experiences, emotions, values, and team interactions affected decision-making, as did external factors such as the emergency medical service system and the work environment, the legislation, and the cardiac arrest setting. Lastly, prehospital resuscitation providers’ had to navigate conflicts between jurisdiction and guidelines, and conflicting values and interests. Conclusions Our findings underline the complexity in prehospital resuscitation decision-making and highlight the need for further research on non-medical factors in out-of-hospital cardiac arrest.

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“…These injuries or injury sequelae can and should be addressed as soon as possible, preferably before the patient is transported to the hospital. Over the past years, the prehospital management of patients with TCA has gained a lot of attention in the Netherlands through more in depth education and training for both EMS and HEMS personnel, based on the latest European resuscitation committee guidelines (3). Whether this has led to survival rates comparable to those published in recent literature is currently unknown (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Outcomes after Prehospital Traumatic Cardiac Arrest in the Netherlands: a Retrospective Cohort Study

Houwen

Popal

Bruijn

et al. 2021

Injury

Self Cite

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Decision making in prehospital traumatic cardiac arrest; A qualitative study

Cited by 15 publications

References 15 publications

Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests

Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests

Non-medical factors in prehospital resuscitation decision-making: a mixed-methods systematic review

Outcomes after Prehospital Traumatic Cardiac Arrest in the Netherlands: a Retrospective Cohort Study

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