Cardiopulmonary resuscitation (CPR) is defined as chest compressions and rescue breaths and is a subset of resuscitation. Championed for the treatment for out-of-hospital cardiac arrest, CPR is now commonplace for in-hospital cardiac arrest (IHCA).
Method
An online survey of staff involved in resuscitation for IHCA sought demographic information, perceptions on the CPR definition, survival rates from IHCA and perceptions in clinical scenarios.
Results
Of 500 complete responses, specialties with representation included emergency medicine (25%), intensive care (14%) and cardiology (12%). Ninety-seven percent of respondents believed that CPR for IHCA included defibrillation, while 57.2% believed it included comprehensive resuscitation. 65% discussed defibrillation in CPR discussions with patients. Forty-eight percent of respondents offered CPR for IHCA with underlying metastatic malignancy, despite 62.4% estimating survival at <5%. In IHCA with severe aortic stenosis, 43% of those who estimated survival to be <10% would offer CPR. In elderly myocardial infarction, 29% would offer defibrillation alone. In refractory arrhythmic IHCA, 69.2% would offer further CPR and defibrillation while 36% would stop therapy and allow natural death.
Conclusion
The common use of CPR in hospital level care reflects the broader definition of resuscitation. Offering CPR in situations with recognized poor outcomes was commonplace. Evidently for cardiology patients a more nuanced process is required. Recapturing the definition of CPR for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to offer some forms of resuscitation as part of restorative treatment without CPR and facilitate the withholding CPR when potentially futile.
Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out-of-hospital cardiac arrest, CPR is now frequently used for in-hospital cardiac arrest (IHCA) with different causes and outcomes.This paper aims to describe clinical understanding of the role of in-hospital CPR and perceived outcomes for IHCA.An online survey of a secondary care staff involved in resuscitation was conducted, focussing on definitions of CPR, features of do-not-attempt-CPR conversations with patients and clinical case scenarios. Data were analysed using a simple descriptive approach.Of 652 responses, 500 were complete and used for analysis. Two hundred eleven respondents were senior medical staff covering acute medical disciplines. Ninety-one percent of respondents agreed or strongly agreed that defibrillation is part of CPR, and 96% believed CPR for IHCA included defibrillation. Responses to clinical scenarios were dissonant, with nearly half of respondents demonstrating a pattern of underestimating survival and subsequently showing a desire to offer CPR in similar scenarios with poor outcomes. This was unaffected by seniority and level of resuscitation training.The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision-making around patient deterioration. This may involve reframing current in-hospital algorithms and uncoupling CPR from wider resuscitative measures.
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