Swedish ambulance nurses' experiences of nursing patients suffering cardiac arrest

Effective pre‐hospital treatment of a person suffering cardiac arrest is a challenging task for the ambulance nurses. The aim of this study was to describe ambulance nurses’ experiences of nursing patients suffering cardiac arrest. Qualitative personal interviews were conducted during 2011 in Sweden with seven ambulance nurses with experience of nursing patients suffering cardiac arrests. The interview texts were analyzed using qualitative thematic content analysis, which resulted in the formulation of one theme with six categories. Mutual preparation, regular training and education were important factors in the nursing of patients suffering cardiac arrest. Ambulance nurses are placed in ethically demanding situations regarding if and for how long they should continue cardio‐pulmonary resuscitation (CPR) to accord with pre‐hospital cardiac guidelines and patients’ wishes. When a cardiac arrest patient is nursed their relatives also need the attention of ambulance nurses. Reflection is one way for ambulance nurses to learn from, and talk about, their experiences. This study provides knowledge of ambulance nurses’ experiences in the care of people with cardiac arrest. Better feedback about the care given by the ambulance nurses, and about the diagnosis and nursing care the patients received after they were admitted to the hospital are suggested as improvements that would allow ambulance nurses to learn more from their experience. Further development and research concerning the technical equipment might improve the situation for both the ambulance nurses and the patients. Ambulance nurses need regularly training and education to be prepared for saving people's lives and also to be able to make the right decisions.     

Understanding the drugs used during cardiac arrest response

During cardiac arrest the survival of the patient depends on a rapid response that provides high-quality treatment based on the latest guidelines. Administration of the correct drugs is an important aspect of this process and one in which nurses are taking an increasingly important role. This article will help nurses to understand the use of drugs in cardiac arrest resuscitation, explaining the rationale for their use, the dosage and any significant problems likely to be encountered.     

Evaluation of a cardiac surgery advanced life support course

The most critical emergency situation seen in cardiac surgical units is the need for chest reopening. While senior nurses often manage cardiac arrest they currently are not trained to open chests, which can be a life-saving action if performed efficiently. This article evaluates a three-day cardiac surgery advanced life support course with protocols to manage critically ill cardiac surgical patients who suffer a cardiac arrest and who need their chest reopening.     

Nursing Roles and Responsibilities With Cardiopulmonary Arrest in Radiology/Procedural Areas

More than 600,000 people sustain cardiac arrest in the United States annually. Of these, approximately 290,000 occur in-hospital. In the United States, the incidence of in-hospital cardiac arrest is 9 to 10 per 1,000 admissions. Patients can sustain cardiac arrest in various hospital settings, including in radiology and other procedural areas. Although the incidence of cardiac arrest in these areas is considered low, these cases continue to rise. Data from a retrospective study from 2002 to 2007 revealed that 0.002% of patients were victims of cardiac arrest during procedures. In contrast, a more recent study revealed that this number jumped to 0.006% between 2014 and 2020. While these events are often unexpected, nurses in radiology and procedural areas have a pivotal role in identifying patients at risk and promptly implementing emergency interventions to optimize patient outcomes.     

Evaluation of nurses' and doctors' knowledge of basic & advanced life support resuscitation guidelines

Lack of resuscitation skills of nurses and doctors in basic life support (BLS) and advanced life support (ALS) has been identified as a contributing factor to poor outcomes of cardiac arrest victims. Our hypothesis was that nurses’ and doctors’ knowledge of cardiopulmonary resuscitation guidelines would be related to their professional background as well as their resuscitation training. A secondary aim of this study was to assess and compare the theoretical knowledge on BLS and ALS in nurses and doctors. A total of 82 nurses and 134 doctors agreed to respond to a questionnaire containing demographic questions, resuscitation experience questions and 15 theoretical knowledge questions. Our study demonstrated that nurses and doctors working in Greece have knowledge gaps in current BLS and ALS guidelines. However, resuscitation training had a positive effect on theoretical CPR knowledge. Furthermore, nurses and doctors who worked in high-risk areas for cardiac arrest, scored significantly higher than those who worked in low-risk areas. Those who had encountered more than 5 cardiac arrests the previous year, scored significantly better. Finally the percentage of nurses who had attended the ALS course was quite low thus ALS training should be incorporated into the nursing curriculum.     

Defibrillation 2: Using defibrillators in hospital

Patients who have a cardiac arrest in hospital should, if it is indicated, be defibrillated as quickly as possible--ideally within three minutes. Most hospital wards and other clinical areas have access to defibrillators with both advisory (semi-automated) and manual modes. The former enables first responders, including nurses without ECG interpretation skills, to defibrillate the patient while awaiting the arrival of the cardiac arrest team who can then select and use the manual mode. Most hospital nurses will be trained in advisory defibrillation, while a few will be trained in manual defibrillation. This article provides an overview of defibrillation in hospital, and looks at both advisory and manual defibrillation.     

Surviving sudden loss: When life, death, and technology collide

Patients who survive sudden cardiac arrest are at risk for anxiety, depression, and other psychosocial difficulties. By exploring the impact of surviving sudden cardiac arrest as it relates to the expectations and emotions of patients and their families, nurses can promote realistic and readily usable processes for facilitation of healthy grieving, adaptive coping, and reinvestment in life.     

Nurses' behaviour regarding CPR and the theories of reasoned action and planned behaviour.

Cardiopulmonary resuscitation (CPR) has been used in hospitals for approximately 40 years. Nurses are generally the first responders to a cardiac arrest and initiate basic life support while waiting for the advanced cardiac life support team to arrive. Speed and competence of the first responder are factors contributing to the initial survival of a person following a cardiac arrest. Attitudes of individual nurses may influence the speed and level of involvement in true emergency situations. This paper uses the theories of reasoned action and planned behaviour to examine some behavioural issues with CPR involvement.     

A strategy for nurse defibrillation in general wards

Reducing the delay to defibrillation has a major impact on chance of survival from cardiac arrest. A high proportion of cardiac arrests occur in general ward areas, and the teaching and application of defibrillation is as much a priority there as in high dependency areas. The patients most likely to survive in-hospital cardiac arrests are those whom return of spontaneous circulation had been achieved by the first responder. In most clinical areas the first responder is likely to be a nurse. Nurses in Brighton had been taught manual defibrillation for many years, but were often reluctant to use their skills. We introduced a course specifically designed for ward nurses, covering rhythm recognition and defibrillation, with the objective of training large numbers and making the skill so prevalent that it would become an accepted nurse procedure. RESULTS: Ninety-eight nurses were trained during 1996. By the end of that year, nurses in general ward areas performed defibrillation in 80% of all cases where a shock was required at any time during the resuscitation attempt. However, only 3/25 (12%) of patients in a primary shockable rhythm were defibrillated before a member of the cardiac arrest team arrived. One hundred and forty-nine additional nurses were trained during 1997/8. By the end of this two year period there was no increase in the overall percentage of nurse defibrillations, but the number of patients in primary VF/VT defibrillated before the arrival of the cardiac arrest team had markedly increased to 17/37 (46%, P < 0.02). During this period the overall hospital survival to discharge from primary VF/VT showed a non significant improvement from 41 to 55%. CONCLUSION: We believe that it is not sufficient simply to permit nurse defibrillation, it must be perceived as a routine skill within the environment of an acute hospital.     

Neurologic outcome following pediatric resuscitation

This study reports the survival rate and short-term neurologic outcome of children who sustained cardiac arrests at Henrietta Egleston Hospital for Children, a pediatric teaching hospital. A commonly held belief in pediatric centers has been that children tolerate the insult of cardiac arrest better than adults. Cardiac arrest was defined as the need for external or internal cardiac compressions. Critical care nurses specially trained for this project collected the arrest data and performed the serial neurological exams. Results showed that despite a low overall survival rate, neurological outcome appears to be good after the arrest even in patients who expire prior to discharge. Major neurologic deficits, such as hemiplegia and severe developmental delay, do not occur. Nursing implications of the study, which is in its second year, are discussed.     

围手术期病人心跳骤停的危险因素分析及对策

目的探讨围手术期病人心跳骤停的原因,并提出相应的护理对策,为改善围手术期病人的护理措施提供科学依据。方法采用病历回顾的方法,对围手术期病人心跳骤停的危险因素进行单因素和多因素Logistic回归分析。结果61051例手术病人发生围手术期心跳骤停19例,发生率为3．1／万。病人高龄、ASA分级差、术中缺氧、失血性休克、低血钾、代谢性酸中毒、迷走神经反射是围手术期病人发生心跳骤停的危险因素。结论术前改善择期手术病人特别是高龄病人的身体机能;手术室护士在术中严密观察病人的病情变化,及时纠正电解质平衡紊乱,对减少围手术期病人心跳骤停发生率具有积极的意义。     

To lead or not to lead? Prospective controlled study of emergency nurses' provision of advanced life support team leadership

Background and objectives: In many emergency departments advanced life support (ALS) trained nurses do not assume a lead role in advanced resuscitation. This study investigated whether emergency nurses with previous ALS training provided good team leadership in a simulated cardiac arrest situation. Methods: A prospective study was conducted at five emergency departments and one nurses'' association meeting. All participants went through the same scenario. Details recorded included baseline blood pressure and pulse rate, time in post, time of ALS training, and subjective stress score (1 = hardly stressed; 10 = extremely stressed). Scoring took into account scenario understanding, rhythm recognition, time to defibrillation, appropriateness of interventions, and theoretical knowledge. Results: Of 57 participants, 20 were ALS trained nurses, 19 were ALS trained emergency senior house officers (SHOs), and 18 were emergency SHOs without formal ALS training. The overall mean score for doctors without ALS training was 69.5%, compared with 72.3% for ALS trained doctors and 73.7% for ALS trained nurses. Nurses found the experience less stressful (subjective stress score 5.78/10) compared with doctors without ALS training (6.5/10). The mean time taken to defibrillate from the appearance of a shockable rhythm on the monitor by the nurses and those SHOs without ALS training was 42 and 40.8 seconds, respectively. Conclusion: ALS trained nurses performed as well as ALS trained and non ALS trained emergency SHOs in a simulated cardiac arrest situation and had greater awareness of the potentially reversible causes of cardiac arrest. Thus if a senior or middle grade doctor is not available to lead the resuscitation team, it may be appropriate for experienced nursing staff with ALS training to act as ALS team leaders rather than SHOs.     

Use of advanced life support skills

BACKGROUND: The Advanced Life Support (ALS) Provider Course trains healthcare professionals in a standardised approach to the management of a cardiac arrest. In the setting of limited resources for healthcare training, it is important that courses are fit for purpose in addressing the needs of both the individual and healthcare system. This study investigated the use of ALS skills in clinical practice after training on an ALS course amongst members of the cardiac arrest team compared to first responders. METHODS: Questionnaires measuring skill use after an ALS course were distributed to 130 doctors and nurses. RESULTS: 91 replies were returned. Basic life support, basic airway management, manual defibrillation, rhythm recognition, drug administration, team leadership, peri- and post-arrest management and resuscitation in special circumstances were used significantly more often by cardiac arrest team members than first responders. There was no difference in skill use between medically and nursing qualified first responders or arrest team members. CONCLUSION: We believe that the ALS course is more appropriately targeted to members of a cardiac arrest team. In our opinion the recently launched Immediate Life Support course, in parallel with training in the recognition and intervention in the early stages of critical illness, are more appropriate for the occasional or first responder to a cardiac arrest.     

Seeking an explanation for the poor uptake of in-hospital AED programs.

The automated external defibrillator (AED) has been adopted by emergency service personnel as a first-line intervention in the management of out-of-hospital cardiac arrest (OHCA). AED leads to more successful Advanced Cardiac Life Support; consequently, national resuscitation organisations worldwide have recommended that nurses and doctors also integrate AEDs as a component of their basic life-support response to cardiac arrest. Despite these recommendations, the implementation of AED programs within hospitals has been generally sporadic and isolated. A continuation of this situation will most likely disturb and perplex nurses and patients, as they are key stakeholders with respect to upholding recommended BLS practices. In the absence of any explanation from change agents within hospitals, this paper seeks, by way of a pilot study and a review of the literature, to identify the extent of the problem and identify factors contributing to the relatively slow uptake of this device. We argue that nurses and other first responders to in-hospital cardiac arrest (CA) have much to gain, in the context of Occupational Health Safety and Welfare (OHS and W), from ready access to AEDs. Cost factors are also considered, with initial cost of AED purchase likely to be a major concern for managers of hospital budgets. The issues we discuss in this paper clearly support the need for further research to (a) explain the nature of public hospital resistance to AEDs and (b) to consider whether AEDs will provide practical advantages to public hospitals from an occupational, social and economic perspective.     

Education for cardiac arrest – Treatment or prevention?

In-hospital cardiac arrests (IHCA) occur infrequently and individual staff members working on general wards may only rarely encounter one. Mortality following IHCA is high and the evidence for the benefits of many advanced life support (ALS) interventions is scarce. Nevertheless, regular, often frequent, ALS training is mandatory for many hospital medical staff and nurses. The incidence of pre-cardiac arrest deterioration is much higher than that of cardiac arrests, and there is evidence that intervention prior to cardiac arrest can reduce the incidence of IHCA. This article discusses a proposal to reduce the emphasis on widespread ALS training and to increase education in the recognition and response to pre-arrest clinical deterioration.     

Do health care professionals report sudden cardiac arrest better than laymen?

OBJECTIVE: To compare the emergency calls made by health care providers and by laymen reporting a non-traumatic cardiac arrest, and to evaluate the handling of these calls by dispatchers. METHODS: The study was conducted prospectively over a 1-year period in 1996. The callers (N=328) where divided in to three groups based on profession: I, doctors and nurses (N=33); II, other health care providers (N=19); and III, laymen (N=276). Main outcome measures where the information given by the caller, use of the dispatching protocol, recognition of the cardiac arrest, and survival to hospital. RESULTS: Doctors and nurses told the dispatcher spontaneously what had happened in 67% of the calls when total strangers to the patient told it in 72%. Group I gave no information about the vital signs in 24% of the calls, group II in 0% and group III in 6%. Of the 52 phone calls made by groups I and II, in six cases the patient was not in cardiac arrest, in four the patient had already irreversible signs of death and in four only transportation to another hospital was requested for a patient in cardiac arrest. Of the professionals calling, 49 (94%) were on duty at the time of the call. The cardiac arrest was recognized by the dispatcher in group I in 70%, in group II in 74% and in group III in 73%. There where no statistical differences between the groups. CONCLUSIONS: Our data do suggest that health care professionals, excluding those in emergency medicine, are not better than laymen in evaluating an emergency situation correctly, and when the caller is a doctor or a nurse the dispatcher seems to trust the evaluation of the situation to be correct and rarely asks any clarifying questions about vital signs of the patient.     

Inducing hypothermia to decrease neurological deficit: literature review

AIM: This paper reports a literature review to examine the effectiveness of inducing hypothermia to decrease neurological deficit after out-of-hospital cardiac arrest. BACKGROUND: After cardiac arrest, severe neurological impairment is a major problem. Outcome after anoxic brain injury following cardiac arrest varies from normal function to brain death. However, a large proportion of these patients are left with severe disability and completely dependent on others for basic needs. Since the 1950s, several studies have shown how hypothermia can be neuroprotective. Recently, these studies have been taken to human trials in populations experiencing out-of-hospital cardiac arrest. METHODS: A literature search was conducted using the Ovid and MDConsult databases for the years 1966-2004 and the keywords included hypothermia, therapeutic hypothermia, and cardiac arrest. Only English language papers were retrieved. Six human trials were found. RESULTS: All six studies showed improved neurological outcomes and four of these showed a decrease in mortality. Minimal complications exist from inducing mild hypothermia after cardiac arrest, and include decreased heart rate, increased systemic vascular resistance, transient electrolyte abnormalities (increased serum potassium and glucose), possible increase in pneumonia or other infectious processes, possible rebound hyperthermia, possible hypotension, and possible arrhythmias. CONCLUSIONS: Based on the review of these studies and the recommendations from the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation, advanced practice nurses should promote this practice, but look for further research on specific treatment recommendations.     

Ways of understanding cognitive impairment in cardiac arrest survivors: A phenomenographic study

AimTo describe the variation in ways that registered nurses perceive and understand cognitive impairment in cardiac arrest survivors.DesignA qualitative, inductive design with individual semi-structured interviews was applied. Data was analysed using a phenomenographic approach.SettingThe participants were nineteen Swedish registered nurses, experienced in cardiovascular care and providing follow-up care.FindingsThe nurses perceived the cognitive impairment of the survivors in qualitatively different ways, as illustrated in two categories: ‘The perceptible and obvious’ and ‘The elusive and challenging’. The nurses perceived a variety of signs of cognitive impairment, emotional expressions related to these, and recovery from cognitive impairment. They perceived confidence in capturing cognitive function when they understood the signs of cognitive impairment as severe and obvious. However, it was perceived as difficult to assess cognitive function when impairments were subtle, resulting in uncertainty in terms of how to make assessments. Nurses made use of their own strategies for assessments, which were sometimes found to be inadequate when they understood that they had misinterpreted the survivors’ cognitive impairment.ConclusionNurses feel uncertainty regarding detecting mild impairment in cardiac arrest survivors. By involving next of kin, nurses will gain a broader understanding of survivors’ cognitive function.