Ethical dilemmas during cardiac arrest incidents in the patient's home.

BACKGROUND:: The majority (70%) of cardiac arrests in Sweden are experienced in the patient's home. In these situations, the ambulance nurses may encounter several ethical dilemmas. AIM:: The aim was to investigate Swedish specialist ambulance nurses' experiences of ethical dilemmas associated with cardiac arrest situations in adult patients' homes. METHODS:: Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis. ETHICAL CONSIDERATIONS:: Ethical principles mandated by the Swedish Research Council were carefully followed during the whole process. FINDINGS:: Two main themes with six sub-themes were identified: The scene - creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients' integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being's dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human. CONCLUSION:: The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient's dignity and to serve life and health.

Effectiveness of Intubating Laryngeal Mask Airway in managing out-of-hospital cardiac arrest by non-physicians.

AIM OF THE STUDY: The role of supraglottic devices in airway management in out-of-hospital cardiac arrest (OHCA) remains controversial. The aim of this study was to evaluate the feasibility and effectiveness of intubation through the Intubating Laryngeal Mask Airway (ILMA) when used by prehospital emergency nurses in the setting of OHCA. METHODS: We conducted a prospective, observational trial during 12 years by the Fire Department and prehospital emergency service of the health district of Strasbourg, France. The primary outcome was the success rate of ventilation after intubation through the ILMA, while the secondary outcomes were the success rate of ventilation after insertion of the ILMA and complications related to ILMA placement and intubation. Factors associated with successful intubation were also studied. RESULTS: During the study period, 1464 ILMA placements were attempted by emergency nurses during OHCA. Ventilation was possible in 1250 patients (85.38%) after ILMA placement and in 1078 patients (73.63%) after intubation. Regurgitation of gastric contents occurred in 237 (16.18%) patients, mostly during basic life support. Two factors were predictive of a successful tracheal intubation: the performance of the Chandy maneuver OR = 2.91 (CI: 2.07-3.97) and the number of attempts at intubation OR = 1.95 (CI: 1.43-2.61). Conversely, the number of attempts at ILMA insertion was predictive of an intubation failure OR = 0.11 (CI: 0.07-0.17). CONCLUSION: The success rate of intubation through the ILMA was high. After ILMA placement, ventilation was possible in 1250 patients (85.38%) and in 1078 patients (73.63%) after intubation.

[Care seen from the other side]. / De l'autre côté du soin.

Treating an out-of-hospital cardiac arrest (OHCA) is a rare event. The experience of a young nurse who suffered an OHCA reminds us of the importance of activating the chain of survival at the earliest possible moment.

Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses.

BACKGROUND: Out-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity in Europe. We aim to investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectiveness of chest compression during CPR. METHODS: This was prospective, randomized, crossover, controlled trial. Following a brief didactic session, 140 volunteer nurses inexperienced with feedback CPR devices attempted chest compression on a manikin using 3 CPR feedback devices (TrueCPR, CPR-Ezy, and iCPR) and standard basic life support (BLS) without feedback. RESULTS: Comparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed differences in the effectiveness of chest compression (compressions with correct pressure point, correct depth, and sufficient decompression), which are, respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs 45.6 vs 39.6 mm); and compression rate (129.4 vs 110.2 vs 101.5 vs 103.5 min(-1)). CONCLUSIONS: During the simulated resuscitation scenario, only TrueCPR significantly affected the increased effectiveness compression compared with standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirm the results in clinical practice.

Family presence at resuscitation attempts.

UK resuscitation guidelines suggest that parents and carers should be allowed to be present during a resuscitation attempt in hospital but no guidance is available regarding family presence when resuscitation takes place out of hospital. A new research study has suggested that relatives who were offered the opportunity to witness resuscitation were less likely to develop symptoms of post-traumatic stress disorder than those who were not given the chance. This article summarises the results of this study and provides an expert commentary on its conclusions.