Wednesday, October 07, 2009

Commentary on Survey of Public's Knowledge/Attitudes about Resuscitation

Research Abstract with Commentary

Cardiopulmonary Resuscitation: Knowledge and Opinions Among the U.S. General Public.
State of the Science-Fiction

BACKGROUND AND OBJECTIVE: Cardiopulmonary resuscitation is undertaken more than 250,000 times annually in the United States. This study was undertaken to determine knowledge and opinions of the general public regarding cardiopulmonary resuscitation. DESIGN: Validated multisite community-based cross-sectional survey. OUTCOME MEASURES: Knowledge and opinions about resuscitative practices and outcomes, using hypothetical clinical scenarios and other social, spiritual, and environmental considerations. RESULTS: Among 1831 participants representing 38 states, markedly inaccurate perceptions of cardiac arrest were reported. Participants' mean estimate of predicted survival rate after cardiac arrest was 54% (median 50%, IQR 35-75%), and mean estimated duration of resuscitative efforts in the ED was 28min (median 15min; IQR 10-30). Projected age and health status were independent predictors of resuscitation preferences in a series of 4 hypothetical scenarios. Participants indicated that physicians should consider patient and family wishes as the most important factors when making resuscitation decisions. Participants considered advanced technology and physician communication to be the most important actions during attempted resuscitation. CONCLUSIONS: Inaccurate perceptions regarding resuscitation and survival rates exist among the lay public. Participants indicated strong preferences regarding resuscitation and advance directives.

Marco, C. A., & Larkin, G. L. (2008). Cardiopulmonary resuscitation: Knowledge and opinions among the U.S. general public. State of the science-fiction. Resuscitation, 79, 490-498.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

This interesting study, published in 2008, features data collected in 2000. This is disappointing considering the factors that may have changed since 2000. The researchers surveyed people in airport and bus terminals, hospital waiting rooms, shopping malls, and college campuses in Pennsylvania and Ohio. The participants – while closely resembling the data from the U. S. census – may under-represent Hispanic persons, and over-represent older, single, and highly educated persons who are mobile.

It is interesting to note that respondents overestimated success rates for resuscitation results, and that 91% of them were willing to undergo CPR. However, smaller proportions would find the following procedures acceptable:
 74% chest compressions
 64% mouth-to-mouth breathing
 61% electrical shocks (defibrillation)
 54% intravenous medications
 42% artificial breathing on a respirator
 31% large intravenous lines in the neck or groin
This indicates understanding deficits as to what “resuscitation” actually involves!

Anyone interested in replicating the study with our patients and families? The survey used is published with the article, and is available in Spanish.

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