Provision of Compassionate and Empathic Care as a Well-Being Preservation Tool for Emergency Physicians: A Scoping Review.

Objective: Compassion and physician well-being are two key components related to quality care in health including emergency medicine. The objective of this study was to explore the impact of compassion in care on the well-being of emergency physicians. We conducted a scoping review to explore the impact of provision of compassionate care by emergency physicians on their well-being and subconcepts. Methods: Four electronic databases and grey literature were searched to find evidence related to compassion, empathy, self-compassion, and their impact on emergency physicians' well-being. Following title and abstract review, two reviewers independently screened full-text articles, and extracted data. Data were presented using descriptive statistics and a narrative analysis. Results: A total of 803 reports were identified in databases. Three articles met eligibility criteria for data extraction. None directly examined compassion and well-being. Included studies addressed empathy and burnout in emergency medicine professionals. Conclusion: No high-quality evidence could be found on the topic in the population of interest. Literature related to the topic of compassion in physicians, especially in emergency physicians, a field known for its high demand and stress levels, is currently scarce and additional evidence is needed to better describe and understand the association between physicians' compassion and well-being.

Defibrillation energy dose during pediatric cardiac arrest: Systematic review of human and animal model studies.

OBJECTIVE: To determine the initial defibrillation energy dose that is associated with sustained return of spontaneous circulation (ROSC) during paediatric cardiac arrest with ventricular fibrillation or pulseless ventricular tachycardia. METHODS: A systematic review was performed using four databases (PROSPERO: CRD42016036734). Human studies and animal model studies of pediatric cardiac arrest involving assessment of external defibrillation energy dosing were considered. The primary outcome was sustained ROSC. Survival and defibrillation-induced complications were also evaluated. RESULTS: The search strategy identified 14,471 citations of which 232 manuscripts were reviewed. Ten human and 10 animal model studies met the inclusion criteria. Human studies were prospective (n = 6) or retrospective (n = 4) cohort studies and included between 11 and 266 patients (median = 46 patients). Sustained ROSC rates ranged from 0 to 61% (n = 7). No studies reported a statistically significant association between the initial defibrillation energy dose and the rate of sustained ROSC (n = 7) or survival (n = 6). Meta-analysis was not considered appropriate due to clinical heterogeneity. Risk of bias was moderate. All animal studies were randomized controlled trials with 8 and 52 (median = 27) piglets. ROSC was frequently achieved (≥85%) with energy dose ranging from 2 to 7 J/kg (n = 7). The defibrillation threshold varied according to the body weight and appears to be higher in infant. CONCLUSION: Defibrillation energy doses and thresholds varied according to the body weight and trended higher for infants. No definitive association between initial defibrillation doses and the sustained ROSC or survival could be demonstrated. Clinicians should follow local consensus-based guidelines.