Brandling J, Kirby K, Black S, Voss S, Benger J
University of the West of England, Bristol, UK.
South Western Ambulance Service NHS Foundation Trust, Dorchester, UK.
BMC Emerg Med. 2017 Jul 25;17(1):24. doi: 10.1186/s12873-017-0136-3.
There are approximately 60,000 out-of-hospital cardiac arrests (OHCA) in the United Kingdom (UK) each year. Within the UK there are well-established clinical practice guidelines that define when resuscitation should be commenced in OHCA, and when resuscitation should cease. Background literature indicates that decision-making in the commencement and cessation of resuscitation efforts in OHCA is complex, and not comprehensively understood. No relevant research from the UK has been published to date and this research study seeks to explore the influences on UK Emergency Medical Service (EMS) provider decision-making when commencing and ceasing resuscitation attempts in OHCA. The aim of this research to explore the influences on UK Emergency Medical Services provider decision-making when commencing and ceasing resuscitation attempts in OHCA.
Four focus groups were convened with 16 clinically active EMS providers. Four case vignettes were discussed to explore decision-making within the focus groups. Thematic analysis was used to analyse transcripts.
This research found that there are three stages in the decision-making process when EMS providers consider whether to commence or cease resuscitation attempts in OHCA. These stages are: the call; arrival on scene; the protocol. Influential factors present at each of the three stages can lead to different decisions and variability in practice. These influences are: factual information available to the EMS provider; structural factors such as protocol, guidance and research; cultural beliefs and values; interpersonal factors; risk factors; personal values and beliefs.
An improved understanding of the circumstantial, individual and interpersonal factors that mediate the decision-making process in clinical practice could inform the development of more effective clinical guidelines, education and clinical decision support in OHCA. These changes have the potential to lead to greater consistency. and EMS provider confidence, with the potential for improved patient outcome from OHCA.
英国每年约有60000例院外心脏骤停（OHCA）。在英国，有完善的临床实践指南来界定OHCA何时应开始复苏以及何时应停止复苏。背景文献表明，OHCA复苏开始和停止的决策过程很复杂，尚未得到全面理解。迄今为止，英国尚未发表相关研究，本研究旨在探讨在OHCA开始和停止复苏尝试时，对英国紧急医疗服务（EMS）提供者决策的影响。本研究的目的是探讨在OHCA开始和停止复苏尝试时，对英国紧急医疗服务提供者决策的影响。
召集了4个焦点小组，共有16名仍在临床一线工作的EMS提供者参与。讨论了4个病例 vignettes，以探讨焦点小组内的决策情况。采用主题分析法对文字记录进行分析。
本研究发现，当EMS提供者考虑是否在OHCA中开始或停止复苏尝试时，决策过程有三个阶段。这些阶段是：接到呼叫；到达现场；遵循协议。三个阶段中存在的影响因素可能导致不同的决策和实践中的差异。这些影响因素包括：EMS提供者可获得的事实信息；协议、指南和研究等结构因素；文化信仰和价值观；人际因素；风险因素；个人价值观和信仰。
更好地理解在临床实践中调节决策过程的环境、个人和人际因素，可为制定更有效的OHCA临床指南、教育和临床决策支持提供参考。这些变化有可能带来更大的一致性，以及EMS提供者的信心，并有可能改善OHCA患者的预后。
