Disparities in Bystander Cardiopulmonary Resuscitation Performed by a Family Member and a Non-family Member

Sato, Nobuhiro; Matsuyama, Tasuku; Kitamura, Tetsuhisa; Hirose, Yasuo

doi:10.2188/jea.je20200068

Cited by 11 publications

(12 citation statements)

References 32 publications

(35 reference statements)

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“…Besides, more OHCAs occurred at home where the witnesses present during the time of lockdown are most likely to be family members, and are less likely to do cardiopulmonary resuscitation due to emotional involvement and psychological factors. [22][23][24] Finally, OHCA occurring in patients who were hypoxaemic with COVID-19, and OHCA related to advanced cardiac injury such as in late presenters of acute myocardial infarction, might have worse survival compared with OHCA of cardiac origin.…”

Section: Discussionmentioning

confidence: 99%

Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study

Marijon¹,

Karam²,

Jost³

et al. 2020

The Lancet Public Health

424

407

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Background Although mortality due to COVID-19 is, for the most part, robustly tracked, its indirect effect at the population level through lockdown, lifestyle changes, and reorganisation of health-care systems has not been evaluated. We aimed to assess the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in an urban region during the pandemic, compared with non-pandemic periods. MethodsWe did a population-based, observational study using data for non-traumatic OHCA (N=30 768), systematically collected since May 15, 2011, in Paris and its suburbs, France, using the Paris Fire Brigade database, together with in-hospital data. We evaluated OHCA incidence and outcomes over a 6-week period during the pandemic in adult inhabitants of the study area. Findings Comparing the 521 OHCAs of the pandemic period (March 16 to April 26, 2020) to the mean of the 3052 total of the same weeks in the non-pandemic period (weeks 12-17, 2012-19), the maximum weekly OHCA incidence increased from 13•42 (95% CI 12•77-14•07) to 26•64 (25•72-27•53) per million inhabitants (p<0•0001), before returning to normal in the final weeks of the pandemic period. Although patient demographics did not change substantially during the pandemic compared with the non-pandemic period (mean age 69•7 years [SD 17] vs 68•5 [18], 334 males [64•4%] vs 1826 [59•9%]), there was a higher rate of OHCA at home (460 [90•2%] vs 2336 [76•8%]; p<0•0001), less bystander cardiopulmonary resuscitation (239 [47•8%] vs 1165 [63•9%]; p<0•0001) and shockable rhythm (46 [9•2%] vs 472 [19•1%]; p<0•0001), and longer delays to intervention (median 10•4 min [IQR 8•4-13•8] vs 9•4 min [7•9-12•6]; p<0•0001). The proportion of patients who had an OHCA and were admitted alive decreased from 22•8% to 12•8% (p<0•0001) in the pandemic period. After adjustment for potential confounders, the pandemic period remained significantly associated with lower survival rate at hospital admission (odds ratio 0•36, 95% CI 0•24-0•52; p<0•0001). COVID-19 infection, confirmed or suspected, accounted for approximately a third of the increase in OHCA incidence during the pandemic.Interpretation A transient two-times increase in OHCA incidence, coupled with a reduction in survival, was observed during the specified time period of the pandemic when compared with the equivalent time period in previous years with no pandemic. Although this result might be partly related to COVID-19 infections, indirect effects associated with lockdown and adjustment of health-care services to the pandemic are probable. Therefore, these factors should be taken into account when considering mortality data and public health strategies.

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Section: Discussionmentioning

confidence: 99%

Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study

Marijon¹,

Karam²,

Jost³

et al. 2020

The Lancet Public Health

424

407

View full text Add to dashboard Cite

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“… 10 It could be postulated that although OHCA events occurred at home where family may be present, they may be less likely to commence CPR due to psychological and emotional effects of the sudden event. 25 …”

Section: Discussionmentioning

confidence: 99%

Incidence and outcome of out-of-hospital cardiac arrests in the COVID-19 era: A systematic review and meta-analysis

et al. 2020

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Background The impact of COVID-19 on pre-hospital and hospital services and hence on the prevalence and outcomes of out-of-hospital cardiac arrests (OHCA) remain unclear. The review aimed to evaluate the influence of the COVID-19 pandemic on the incidence, process, and outcomes of OHCA. Methods A systematic review of PubMed, EMBASE, and pre-print websites was performed. Studies reporting comparative data on OHCA within the same jurisdiction, before and during the COVID-19 pandemic were included. Study quality was assessed based on the Newcastle-Ottawa Scale. Results Ten studies reporting data from 35,379 OHCA events were included. There was a 120% increase in OHCA events since the pandemic. Time from OHCA to ambulance arrival was longer during the pandemic (p = 0.036). While mortality (OR = 0.67, 95%-CI 0.49-0.91) and supraglottic airway use (OR = 0.36, 95%-CI 0.27-0.46) was higher during the pandemic, automated external defibrillator use (OR = 1.78 95%-CI 1.06-2.98), return of spontaneous circulation (OR = 1.63, 95%-CI 1.18-2.26) and intubation (OR = 1.87, 95%-CI 1.12-3.13) was more common before the pandemic. More patients survived to hospital admission (OR = 1.75, 95%-CI 1.42-2.17) and discharge (OR = 1.65, 95%-CI 1.28-2.12) before the pandemic. Bystander CPR (OR = 1.08, 95%-CI 0.86-1.35), unwitnessed OHCA (OR = 0.84, 95%-CI 0.66-1.07), paramedic-resuscitation attempts (OR = 1.19 95%-CI 1.00-1.42) and mechanical CPR device use (OR = 1.57 95%-CI 0.55-4.55) did not defer significantly. Conclusions The incidence and mortality following OHCA was higher during the COVID-19 pandemic. There were significant variations in resuscitation practices during the pandemic. Research to define optimal processes of pre-hospital care during a pandemic is urgently required. Review registration PROSPERO (CRD42020203371).

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“…Varios estudios demuestran que la familia hubiera querido estar presente en el proceso de reanimación del fallecido y que creen que su presencia hubiera podido ser de utilidad para el equipo sanitario (15,(17)(18)(19)(20) . Es frecuente el sentimiento de desesperanza en estos casos (21)(22)(23) . Además, supone un impacto emocional enorme (18,20,(24)(25)(26)(27) .…”

Section: Categorías De Análisis De Los Resultadosunclassified

“…Atendiendo a esta recomendación, no parece que esté claro en qué situaciones concretas se debe permitir la presencia de familiares (12,(16)(17)(18)(19)30) . Además, la decisión parte exclusivamente del equipo sanitario (15,20,23,24,26,27,29) .…”

Section: Categorías De Análisis De Los Resultadosunclassified

“…Barreras que aportan los profesionales a la implantación de los programas de presencia de familiares en caso de PCR extrahospitalaria en el adulto De acuerdo con Colbert y colaboradores (33) , parece que las principales barreras para lograr la presencia de familiares durante las maniobras de RCP las muestran los profesionales sanitarios, que creen que la calidad asistencial puede verse afectada, tienen la falsa creencia de generar un duelo patológico en los familiares, manifiestan miedo a las demandas legales y temen sentirse sobrecargados en una situación que pudiera requerir mucho esfuerzo para ellos. El miedo a la responsabilidad ética y legal es también una barrera (12,13,15,19,23,27,28) . Además, no existe un acuerdo tácito entre si la presencia de familiares facilita la interrupción de las maniobras de reanimación o dificulta las decisiones asistenciales (30) .…”

Section: Ventajas De Los Programas De Presencia De Familiares En Pcr Extrahospitalaria En El Adultounclassified

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Análisis de los programas para la presencia de familiares en la parada cardiorrespiratoria extrahospitalaria en paciente adulto

García

2021

Enf Global

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Objetivo: Explorar los programas orientados a la participación de familiares en situaciones de PCR en adultos en el medio extrahospitalario.Método: Revisión narrativa de la literatura científica, en bases de datos primarias (Scielo, PubMed, Cuiden y Cochrane Plus y CINAHL), con empleo de lenguaje estructurado DeCS y MeSH, de 2005 a 2020, en español e inglés. Se obtienen 23 estudios.Resultados: Los estudios muestran que el duelo de los familiares de una parada cardiorrespiratoria en el medio extrahospitalario es menos traumática si se les permite estar presentes. Permanecer junto a la víctima debe asegurarse salvo que el profesional considere que es perjudicial. Las ventajas de la presencia de familiares son tanto para el familiar como para el equipo asistencial. A pesar de existir una necesidad social y ética de acuerdo con el principio de autonomía del paciente para la implementación de estos programas apenas existen y esto suele ser debido a las resistencias generadas por los propios profesionales o los gestores.Conclusiones: Las principales sociedades científicas internacionales recomiendan en caso de PCR en el adulto en el medio extrahospitalario, la implantación de programas para la presencia de familiares, lo que hace que se convierta en una necesidad. La literatura científica demuestra más ventajas que inconvenientes, fundamentalmente en cuanto a un mejor duelo en familiares y mayor satisfacción y menor posibilidad de demandas jurídicas en los sanitarios, promoción de la humanización de los cuidados que se traduciría en un gasto asistencial menor en prevalencia de duelo patológico. Objective: Explore programs aimed at the participation of family members in situations of CRP in adults in the out-of-hospital setting.Method: Narrative review of the scientific literature, in primary databases (Scielo, PubMed, Cuiden and Cochrane Plus and CINAHL), using DeCS and MeSH structured language, from 2005 to 2020, in Spanish and English. 23 studies are obtained.Results: Studies show that mourning for family members of a cardiorespiratory arrest in the out-of-hospital setting is less traumatic if they are allowed to be present. Staying with the victim must be ensured unless the professional considers that it is harmful. The advantages of the presence of family members are as much for the family member as for the healthcare team. Despite the existence of a social and ethical need in accordance with the principle of patient autonomy for the implementation of these programs, they hardly exist and this is usually due to the resistance generated by the professionals or managers themselves.Conclusions: In the case of cardiorespiratory arrest in adults in the out-of-hospital setting, the main international scientific societies recommend the implementation of programs for the presence of family members, which makes it a necessity. The scientific literature demonstrates more advantages than disadvantages, fundamentally in terms of better grief in family members and greater satisfaction and less possibility of legal claims in health professionals, promoting the humanization of care that would translate into lower healthcare costs in the prevalence of grief pathological. Objetivo: explorar programas voltados à participação de familiares em situação de PCR em adultos no ambiente extra-hospitalar.Método: revisão narrativa da literatura científica, em bases de dados primárias (Scielo, PubMed, Cuiden e Cochrane Plus e CINAHL), utilizando a linguagem estruturada DeCS e MeSH, de 2005 a 2020, em espanhol e inglês. 23 estudos foram obtidos.Resultados: estudos mostram que o luto de familiares por parada cardiorrespiratória em ambiente extra-hospitalar é menos traumático se eles puderem estar presentes. A permanência com a vítima deve ser assegurada, a menos que o profissional considere prejudicial. As vantagens da presença de familiares são tanto para o familiar quanto para a equipe de saúde. Apesar da existência de uma necessidade social e ética de acordo com o princípio da autonomia do paciente para a implantação desses programas, eles quase não existem e isso geralmente se deve às resistências geradas pelos próprios profissionais ou pelos gestores.Conclusões: as principais sociedades científicas internacionais recomendam, no caso da PCR em adultos em ambiente extra-hospitalar, a implantação de programas de presença de familiares, o que a torna uma necessidade. A literatura científica mostra mais vantagens do que desvantagens, fundamentalmente em termos de melhor luto nos familiares e maior satisfação e menor possibilidade de demandas judiciais nos trabalhadores da saúde, promovendo a humanização da assistência que se traduziria em menores gastos com saúde nas prevalências do luto patológico.

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Disparities in Bystander Cardiopulmonary Resuscitation Performed by a Family Member and a Non-family Member

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record.

Cited by 11 publications

References 32 publications

Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study

Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study

Incidence and outcome of out-of-hospital cardiac arrests in the COVID-19 era: A systematic review and meta-analysis

Análisis de los programas para la presencia de familiares en la parada cardiorrespiratoria extrahospitalaria en paciente adulto

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