St. Patrick's Hospital, James's Street, Dublin 8, Ireland.
Ir J Med Sci. 2011 Sep;180(3):673-8. doi: 10.1007/s11845-011-0704-6. Epub 2011 Mar 23.
The indications for CPR (cardiopulmonary resuscitation) have expanded greatly since the technique was introduced and theoretically it can be attempted on all prior to death. Policy initiatives (such as the British Medical Association/Royal College of Nursing guidelines) have attempted to provide a clinical rationale for the withholding of inappropriate CPR. Traditionally a care home was felt to be an inappropriate environment to attempt CPR but increased use of advance directives may bring the issue to the fore in this setting.
We elicited the views of managers of care homes regarding resuscitation strategies in hypothetical situations and in actual practice.
A purpose designed questionnaire in two parts was compiled, gathering factual information and employing a Likert scale to gauge opinion about this issue. The survey was conducted among 187 continuing care homes in South London the subjects being the care managers of the homes surveyed.
Responses were obtained from 86 care homes. Care managers would resuscitate 66% of cases of witnessed cardiac arrest but few efforts were reported. Policies in assigning 'Do not resuscitate' orders were referred to by only 9% of homes but 80% of facilities would welcome them, yet 50% would exclude the patient from this discussion. Clear policy guidelines are required for continuing care homes, and advance statements about CPR as part of residents care plans could reduce inappropriate resuscitative efforts and hospital transfers.
自心肺复苏术（CPR）技术问世以来，其适应证已大大扩展，理论上可以对所有濒临死亡的人进行尝试。政策倡议（如英国医学协会/皇家护理学院指南）试图为不适当的 CPR 提供临床理由。传统上，养老院被认为是不适合进行 CPR 的环境，但随着预先指示的使用增加，这个问题可能会在这种环境中突显出来。
我们征求了养老院管理人员对假设情况和实际情况下复苏策略的看法。
编制了一份有针对性的两部分问卷，收集事实信息，并使用李克特量表来衡量对这个问题的看法。该调查在伦敦南部的 187 家持续护理院进行，调查对象是接受调查的养老院的护理经理。
从 86 家养老院获得了回复。在目击的心脏骤停病例中，护理经理会进行复苏的比例为 66%，但很少有努力得到报道。只有 9%的养老院提到了分配“不复苏”命令的政策，但 80%的设施会欢迎这些政策，但 50%的设施会将患者排除在该讨论之外。持续护理院需要明确的政策指南，并且将 CPR 作为居民护理计划的一部分进行预先声明，可以减少不适当的复苏努力和医院转院。
