Culture and Personal Influences on Cardiopulmonary Resuscitation- Results of International Survey

Overview

Journal BMC Med Ethics

Publisher Biomed Central

Specialty Medical Ethics

Date 2019 Dec 28

PMID 31878920

Citations 6

Authors

Janet Ozer

Gadi Alon

Dmitry Leykin

Joseph Varon

Limor Aharonson-Daniel

Sharon Einav

Affiliations

Soon will be listed here.

Abstract

Background: The ethical principle of justice demands that resources be distributed equally and based on evidence. Guidelines regarding forgoing of CPR are unavailable and there is large variance in the reported rates of attempted CPR in in-hospital cardiac arrest. The main objective of this work was to study whether local culture and physician preferences may affect spur-of-the-moment decisions in unexpected in-hospital cardiac arrest.

Methods: Cross sectional questionnaire survey conducted among a convenience sample of physicians that likely comprise code team members in their country (Indonesia, Israel and Mexico). The questionnaire included details regarding respondent demographics and training, personal value judgments and preferences as well as professional experience regarding CPR and forgoing of resuscitation.

Results: Of the 675 questionnaires distributed, 617 (91.4%) were completed and returned. Country of practice and level of knowledge about resuscitation were strongly associated with avoiding CPR performance. Mexican physicians were almost twicemore likely to forgo CPR than their Israeli and Indonesian/Malaysian counterparts [OR1.84 (95% CI 1.03, 3.26), p = 0.038]. Mexican responders also placed greater emphasison personal and patient quality of life (p < 0.001). In multivariate analysis, degree of religiosity was most strongly associated with willingness to forgo CPR; orthodox respondents were more than twice more likely to report having forgone CPR for apatient they do not know than secular and observant respondents, regardless of the country of practice [OR 2.12 (95%CI 1.30, 3.46), p = 0.003].

Conclusions: In unexpected in-hospital cardiac arrest the decision to perform or withhold CPR may be affected by physician knowledge and local culture as well as personal preferences. Physician CPR training should include information regarding predictors of patient outcome at as well as emphasis on differentiating between patient and personal preferences in an emergency.

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References

Jones K, Garg M, Bali D, Yang R, Compton S . The knowledge and perceptions of medical personnel relating to outcome after cardiac arrest. Resuscitation. 2006; 69(2):235-9. DOI: 10.1016/j.resuscitation.2005.07.023. View

Ginsberg G, Kark J, Einav S . Cost-utility analysis of treating out of hospital cardiac arrests in Jerusalem. Resuscitation. 2014; 86:54-61. DOI: 10.1016/j.resuscitation.2014.10.024. View

Aune S, Herlitz J, Bang A . Characteristics of patients who die in hospital with no attempt at resuscitation. Resuscitation. 2005; 65(3):291-9. DOI: 10.1016/j.resuscitation.2004.11.028. View

Eliott J, Olver I . Choosing between life and death: patient and family perceptions of the decision not to resuscitate the terminally ill cancer patient. Bioethics. 2008; 22(3):179-89. DOI: 10.1111/j.1467-8519.2007.00620.x. View

Varon J, Sternbach G, Rudd P, Combs A . Resuscitation attitudes among medical personnel: how much do we really want to be done?. Resuscitation. 1991; 22(3):229-35. DOI: 10.1016/0300-9572(91)90030-3. View

Harris D, Willoughby H . Resuscitation on television: realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama. Resuscitation. 2009; 80(11):1275-9. DOI: 10.1016/j.resuscitation.2009.07.008. View

Vincent J . Forgoing life support in western European intensive care units: the results of an ethical questionnaire. Crit Care Med. 1999; 27(8):1626-33. DOI: 10.1097/00003246-199908000-00042. View

Mebane E, Oman R, Kroonen L, Goldstein M . The influence of physician race, age, and gender on physician attitudes toward advance care directives and preferences for end-of-life decision-making. J Am Geriatr Soc. 1999; 47(5):579-91. DOI: 10.1111/j.1532-5415.1999.tb02573.x. View

Einav S, Alon G, Kaufman N, Braunstein R, Carmel S, Varon J . To resuscitate or not to resuscitate: a logistic regression analysis of physician-related variables influencing the decision. Emerg Med J. 2011; 29(9):709-14. DOI: 10.1136/emermed-2011-200206. View

10.

De Vleminck A, Pardon K, Houttekier D, Van den Block L, Vander Stichele R, Deliens L . The prevalence in the general population of advance directives on euthanasia and discussion of end-of-life wishes: a nationwide survey. BMC Palliat Care. 2015; 14:71. PMC: 4671216. DOI: 10.1186/s12904-015-0068-1. View

11.

Simmes F, Schoonhoven L, Mintjes J, Fikkers B, van der Hoeven J . Incidence of cardiac arrests and unexpected deaths in surgical patients before and after implementation of a rapid response system. Ann Intensive Care. 2012; 2(1):20. PMC: 3425134. DOI: 10.1186/2110-5820-2-20. View

12.

Ditillo B . Should there be a choice for cardiopulmonary resuscitation when death is expected? Revisiting an old idea whose time is yet to come. J Palliat Med. 2002; 5(1):107-16. DOI: 10.1089/10966210252785079. View

13.

Mancini M, Diekema D, Hoadley T, Kadlec K, Leveille M, McGowan J . Part 3: Ethical Issues: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2):S383-96. DOI: 10.1161/CIR.0000000000000254. View

14.

Bunkenborg G, Samuelson K, Poulsen I, Ladelund S, Akeson J . Lower incidence of unexpected in-hospital death after interprofessional implementation of a bedside track-and-trigger system. Resuscitation. 2013; 85(3):424-30. DOI: 10.1016/j.resuscitation.2013.11.023. View

15.

Brummell S, Seymour J, Higginbottom G . Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice. Soc Sci Med. 2016; 156:47-54. DOI: 10.1016/j.socscimed.2016.03.022. View

16.

Dzeng E, Colaianni A, Roland M, Chander G, Smith T, Kelly M . Influence of institutional culture and policies on do-not-resuscitate decision making at the end of life. JAMA Intern Med. 2015; 175(5):812-9. DOI: 10.1001/jamainternmed.2015.0295. View

17.

Morrison L, Kierzek G, Diekema D, Sayre M, Silvers S, Idris A . Part 3: ethics: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122(18 Suppl 3):S665-75. DOI: 10.1161/CIRCULATIONAHA.110.970905. View

18.

Goodlin S, Zhong Z, Lynn J, Teno J, Fago J, Desbiens N . Factors associated with use of cardiopulmonary resuscitation in seriously ill hospitalized adults. JAMA. 1999; 282(24):2333-9. DOI: 10.1001/jama.282.24.2333. View

19.

Richter J, Eisemann M, Zgonnikova E . Doctors' authoritarianism in end-of-life treatment decisions. A comparison between Russia, Sweden and Germany. J Med Ethics. 2001; 27(3):186-91. PMC: 1733385. DOI: 10.1136/jme.27.3.186. View

20.

Manalo M . End-of-Life Decisions about Withholding or Withdrawing Therapy: Medical, Ethical, and Religio-Cultural Considerations. Palliat Care. 2014; 7:1-5. PMC: 4147759. DOI: 10.4137/PCRT.S10796. View