Early changes in hospital resuscitation practices during the COVID-19 pandemic

Secrest, Kayla; Anderson, Theresa M.; Trumpower, Brad; Harrod, Molly; Krein, Sarah L.; Guetterman, Timothy C.; Chan, Paul S.; Nallamothu, Brahmajee K.

doi:10.1016/j.resplu.2022.100317

Cited by 4 publications

(2 citation statements)

References 19 publications

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“… 12 Many acute care hospitals mandated changes in routine processes of patient care to avoid and reduce in-hospital transmission of COVID-19, including universal masking, 13 , 14 visitor restriction policies, 15 , 16 and extra precautions for aerosol generating medical procedures (AGMP). 17 – 19 Training programs also had to adjust to the increasing numbers of patients while mitigating risk. 20 , 21 At the academic hospitals affiliated with the University of Toronto where the authors practice, this involved redeploying residents to the IM clinical teaching units, establishment of COVID-19 teams, and a restructuring of resident call to separate daytime and nighttime shifts.…”

Section: Introductionmentioning

confidence: 99%

Conducting Goals of Care Conversations: Lessons From the COVID-19 Pandemic

Lai

Abdullah

2023

J Palliat Care

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Objective: Internal medicine (IM) residents discuss a patient's goals of care (GOC) as part of their initial consultation. Residents have described inexperience, general discomfort, limited formal teaching, and prognostic uncertainty as barriers to effective GOC conversations. The early COVID-19 pandemic resulted in rapid changes to the healthcare system on the individual, patient, and systemic level that might exacerbate and/or introduce new barriers to IM residents’ GOC conversations. This qualitative study examines how the early COVID-19 pandemic challenged IM residents’ ability to have effective GOC conversations. Methods: Using a constructivist grounded theory approach, participants (n=11) completed a semi-structured interview. Data collection and analysis occurred simultaneously using an open coding, constant comparison process. Interviews were completed until no new themes were identified. Results: Residents self-described their GOC conversations in 5 steps: normalization of the conversation, introduction of expected clinical course, discussion of possible care plans, exploration of the patient's values, and occasionally providing a recommendation. Residents described limited structured teaching around GOC conversations and instead relied on observed role-modelling and self-practice to hone their skillset. Residents described an increased sense of urgency to have GOC conversations due to the uncertainty of clinical course and potential for rapid deterioration of patients with COVID-19. Residents identified restrictive visitor policies as a significant barrier that contributed to feelings of dehumanization. Residents felt that these limitations affected their GOC conversations and potentially resulted in discordant care plans which contributed to moral distress. Conclusion: The early COVID-19 pandemic resulted in several barriers that challenged residents’ ability to conduct effective GOC conversations. This is on the background of previously reported discomfort and limited formal training in conducting GOC conversations. Based on our findings, we present a conceptual model involving teaching validated GOC frameworks, positive role-modelling, and experiential learning to support GOC conversation education in post-graduate medical education.

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Section: Introductionmentioning

confidence: 99%

Conducting Goals of Care Conversations: Lessons From the COVID-19 Pandemic

Lai

Abdullah

2023

J Palliat Care

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“…During the coronavirus disease (COVID-19) pandemic, rescuers have had to take great care to avoid infection by droplet contact given that aerosol exposure events may occur from patients to clinicians, or vice versa, during CPR [ 8 , 9 , 10 , 11 ]. The COVID-19 outbreak has created important changes in resuscitation efforts and requires modifications to conventional practices [ 12 , 13 ]. The use of MCCD has increased since the outbreak of COVID-19, and this trend has continued even in the post-pandemic period [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Cardiopulmonary Resuscitation Using Automatic Compression—Defibrillation Apparatus: An Animal Study and A Manikin-Based Simulation Study

Jung

Roh

et al. 2023

JCM

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Background: Chest compression and defibrillation are essential components of cardiac arrest treatment. Mechanical chest compression devices (MCCD) and automated external defibrillators (AED) are used separately in clinical practice. We developed an automated compression–defibrillation apparatus (ACDA) that performs mechanical chest compression and automated defibrillation. We investigated the performance of cardiopulmonary resuscitation (CPR) with automatic CPR (A-CPR) compared to that with MCCD and AED (conventional CPR: C-CPR). Methods: Pigs were randomized into A-CPR or C-CPR groups: The A-CPR group received CPR+ACDA, and the C-CPR group received CPR+MCCD+AED. Hemodynamic parameters, outcomes, and time variables were measured. During a simulation study, healthcare providers performed a basic life support scenario for manikins with an ACDA, MCCD, and AED, and time variables and chest compression parameters were measured. Results: The animals showed no significant in hemodynamic effects, including aortic pressures, coronary perfusion pressure, carotid blood flow, and end-tidal CO2, and resuscitation outcomes between the two groups. In both animal and simulation studies, the time to defibrillation, time to chest compression, and hands-off time were significantly shorter in the A-CPR group than those in the C-CPR group. Conclusions: CPR using ACDA showed similar hemodynamic effects and resuscitation outcomes as CPR using AED and MCCD separately, with the advantages of a reduction in the time to compression, time to defibrillation, and hands-off time.

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