Tenge Theresa, Schallenburger Manuela, Batzler Yann-Nicolas, Roth Sebastian, M Pembele René, Stroda Alexandra, Böhm Lennert, Bernhard Michael, Jung Christian, Meier Stefan, Kindgen-Milles Detlef, Kienbaum Peter, Schwartz Jacqueline, Neukirchen Martin
Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
Interdisciplinary Center for Palliative Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
Crit Care Explor. 2024 Apr 10;6(4):e1077. doi: 10.1097/CCE.0000000000001077. eCollection 2024 Apr.
Cardiopulmonary resuscitation (CPR) is an exceptional physical situation and may lead to significant psychological, spiritual, and social distress in patients and their next of kin. Furthermore, clinicians might experience distress related to a CPR event. Specialist palliative care (sPC) integration could address these aspects but is not part of routine care.
This study aimed to explore perspectives on sPC integration during and after CPR. A needs assessment for sPC, possible triggers indicating need, and implementation strategies were addressed.
A multiprofessional qualitative semistructured focus group study was conducted in a German urban academic teaching hospital. Participants were clinicians (nursing staff, residents, and consultants) working in the emergency department and ICUs (internal medicine and surgical).
The focus groups were recorded and subsequently transcribed. Data material was analyzed using the content-structuring content analysis according to Kuckartz.
Seven focus groups with 18 participants in total were conducted online from July to November 2022. Six main categories (two to five subcategories) were identified: understanding (of palliative care and death), general CPR conditions (e.g., team, debriefing, and strains), prognosis (e.g., preexisting situation, use of extracorporeal support), next of kin (e.g., communication, presence during CPR), treatment plan (patient will and decision-making), and implementation of sPC (e.g., timing, trigger factors).
Perceptions about the need for sPC to support during and after CPR depend on roles, areas of practice, and individual understanding of sPC. Although some participants perceive CPR itself as a trigger for sPC, others define, for example, pre-CPR-existing multimorbidity or complex family dynamics as possible triggers. Suggestions for implementation are multifaceted, especially communication by sPC is emphasized. Specific challenges of extracorporeal CPR need to be explored further. Overall, the focus groups show that the topic is considered relevant, and studies on outcomes are warranted.
心肺复苏（CPR）是一种特殊的身体状况，可能会给患者及其近亲带来重大的心理、精神和社会困扰。此外，临床医生也可能会经历与心肺复苏事件相关的困扰。整合专科姑息治疗（sPC）可以解决这些问题，但它并非常规护理的一部分。
本研究旨在探讨心肺复苏期间及之后整合专科姑息治疗的观点。针对专科姑息治疗进行了需求评估、表明需求的可能触发因素以及实施策略。
设计、背景和参与者：在德国一家城市学术教学医院开展了一项多专业定性半结构化焦点小组研究。参与者为在急诊科和重症监护病房（内科和外科）工作的临床医生（护理人员、住院医师和顾问）。
焦点小组进行了录音，随后进行转录。根据库卡茨的方法，使用内容结构化内容分析法对数据材料进行分析。
2022年7月至11月在线进行了7个焦点小组讨论，共有18名参与者。确定了六个主要类别（两到五个子类别）：（对姑息治疗和死亡的）理解、心肺复苏的一般情况（如团队、汇报和压力）、预后（如既往情况、体外支持的使用）、近亲（如沟通、心肺复苏期间的在场情况）、治疗计划（患者意愿和决策）以及专科姑息治疗的实施（如时机、触发因素）。
对于心肺复苏期间及之后需要专科姑息治疗提供支持的看法取决于角色、执业领域以及对专科姑息治疗的个人理解。尽管一些参与者将心肺复苏本身视为专科姑息治疗的触发因素，但其他人则将例如心肺复苏前存在的多种合并症或复杂的家庭动态定义为可能的触发因素。实施建议是多方面的，尤其强调专科姑息治疗的沟通。体外心肺复苏的具体挑战需要进一步探索。总体而言，焦点小组表明该主题被认为是相关的，对结果进行研究是有必要的。
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