Kane R S, Burns E A
Department of Medicine, University of Wisconsin, Milwaukee, USA.
J Am Geriatr Soc. 1997 Feb;45(2):154-7. doi: 10.1111/j.1532-5415.1997.tb04500.x.
To describe CPR policies and the procedures for discussing CPR policies of Wisconsin long-term care facilities.
Mail survey and telephone interview.
Information about CPR policy, how policy is disclosed to residents and by whom, emergency medical technician team (EMT) response time, and number of CPR attempts during 1993.
The 1994 survey response rate was 85% (346/ 404 facilities). Four percent of responding facilities maintain a policy of never initiating CPR. Another 23% never initiate CPR but would call an EMT. Lack of efficacy was the usual basis for policies never initiating CPR. About 15% of facilities would initiate CPR only on residents who had previously indicated a preference. On individuals who had not made an advanced directive decision, 57% of facilities would initiate CPR in the event of an arrest. Almost 30% of facilities offering CPR would initiate CPR on unwitnessed arrests. Approximately 51% of all facilities assigned a social worker alone to discuss CPR policy and preference, whereas 12.5% assigned a physician alone or as part of a team. During 1993, an estimated 118 attempts at CPR were reported for 172 facilities with a total of 19,596 licensed beds, for a frequency of one CPR attempt per 166 beds per year.
Poor efficacy in this population was the main reason given for policies of never initiating CPR. Specific factors relating to CPR efficacy, such as EMT response time and ease of maintaining trained staff, were not major influences. Almost 30% of facilities offering CPR would perform it in unwitnessed situations, despite unlikely success. Many decisions about CPR may not be fully informed as nurses and physicians are not often assigned to discuss advance directives with residents or surrogates. Utilization of CPR in nursing homes offering resuscitation is low.
描述威斯康星州长期护理机构的心肺复苏术（CPR）政策以及讨论这些政策的程序。
邮寄调查和电话访谈。
关于CPR政策的信息、政策如何以及由谁向居民披露、紧急医疗技术人员团队（EMT）的响应时间，以及1993年期间的CPR尝试次数。
1994年的调查回复率为85%（404家机构中的346家）。4%的回复机构维持从不启动CPR的政策。另外23%从不启动CPR，但会呼叫EMT。缺乏疗效是从不启动CPR政策的常见依据。约15%的机构仅对先前表示过偏好的居民启动CPR。对于未做出预先指示决定的个体，57%的机构在其心脏骤停时会启动CPR。几乎30%提供CPR的机构会对未被目击的心脏骤停启动CPR。所有机构中约51%仅安排一名社会工作者来讨论CPR政策和偏好，而12.5%仅安排一名医生或安排医生作为团队成员之一来进行讨论。在1993年，据报告，在拥有总计19596张许可床位的172家机构中，估计有118次CPR尝试，即每年每166张床位有一次CPR尝试。
该人群中CPR疗效不佳是从不启动CPR政策的主要原因。与CPR疗效相关的具体因素，如EMT响应时间和维持训练有素的工作人员的难易程度，并非主要影响因素。尽管成功可能性不大，但几乎30%提供CPR的机构会在未被目击的情况下进行CPR。由于护士和医生通常不被安排与居民或代理人讨论预先指示，许多关于CPR的决定可能没有充分的信息依据。提供复苏服务的养老院中CPR的使用率较低。
