To transport or to terminate resuscitation on-site. What factors influence EMS decisions in patients without ROSC? A mixed-methods study
Autor: | Stefanie G. Beesems, Anja J.Th. C.M. de Kruif, Rudolph W. Koster, Corina de Graaf |
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Přispěvatelé: | Cardiology, Graduate School, ACS - Atherosclerosis & ischemic syndromes, Amsterdam Cardiovascular Sciences, ACS - Heart failure & arrhythmias, Epidemiology and Data Science, VU University medical center |
Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Resuscitation
Emergency Medical Services Databases Factual Qualitative property 030204 cardiovascular system & hematology Emergency Nursing Return of spontaneous circulation Transport practices 03 medical and health sciences 0302 clinical medicine Emergency medical services Medicine Humans In patient Multivariable model business.industry 030208 emergency & critical care medicine Explained variation medicine.disease Cardiopulmonary Resuscitation ROSC Advanced life support Emergency Medical Technicians Emergency Medicine OHCA Medical emergency Cardiology and Cardiovascular Medicine business Out-of-Hospital Cardiac Arrest Decision-making |
Zdroj: | Resuscitation, 164, 84-92. Elsevier Ireland Ltd de Graaf, C, de Kruif, A J T C M, Beesems, S G & Koster, R W 2021, ' To transport or to terminate resuscitation on-site. What factors influence EMS decisions in patients without ROSC? A mixed-methods study ', Resuscitation, vol. 164, pp. 84-92 . https://doi.org/10.1016/j.resuscitation.2021.05.005 |
ISSN: | 0300-9572 |
Popis: | Background: If a patient in out-of-hospital cardiac arrest (OHCA) does not achieve return of spontaneous circulation (ROSC) despite advanced life support, emergency medical services can decide to either transport the patient with ongoing CPR or terminate resuscitation on scene. Purpose: To determine differences between patients without ROSC to be transported vs. terminated on scene and explore medical and nonmedical factors that contribute to the decision-making of paramedics on scene. Methods: Mixed-methods approach combining quantitative and qualitative data. Quantitative data on all-cause OHCA patients without ROSC on scene, between January 1, 2012, and December 31, 2016, in the Amsterdam Resuscitation Study database, were analyzed to find factors associated with decision to transport. Qualitative data was collected by performing 16 semi-structured interviews with paramedics from the study region, transcribed and coded to identify themes regarding OHCA decision-making on the scene. Results: In the quantitative Utstein dataset, of 5870 OHCA patients, 3190 (54%) patients did not achieve ROSC on scene. In a multivariable model, age (OR 0.98), public location (OR 2.70), bystander witnessed (OR 1.65), EMS witnessed (OR 9.03), and first rhythm VF/VT (OR 11.22) or PEA (OR 2.34), were independently associated with transport with ongoing CPR. The proportion of variance explained by the model was only 0.36. With the qualitative method, four main themes were identified: patient-related factors, local circumstances, paramedic-related factors, and the structure of the organization. Conclusion: In patients without ROSC on scene, besides known resuscitation characteristics, the decision to transport a patient is largely determined by non-protocollized factors. |
Databáze: | OpenAIRE |
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