Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services : The REAPPROPRIATE international, multi-centre, cross sectional survey

Introduction: Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome. Methods: A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models. Results: Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician's characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P 79 years) and in case of a "poor" first physical impression of the patient (3.45 [2.36-5.05]; P 79 years) and a "poor" first physical impression (0.26 [0.19-0.35]; P <0.0001). Conclusions: The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.Peer reviewe

Studies claiming efficacy of CPR training interventions: Which skills should be assessed and how should data be reported to allow comparison?

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What level of support is required to enable secondary school teachers to effectively teach first aid? A randomized trial

In light of the UK government’s decision to make first aid education mandatory in schools, this article adds to the body of evidence to inform the implementation of this decision. Our research aimed to explore whether providing extra support to teachers increased their confidence to teach first aid, and whether this support influenced student learning outcomes. Thirty-five teachers were randomly allocated into two experimental groups and one control group. The first experimental group received support through a video medium, the second through an interactive webinar. The control group was provided with no support beyond the learning materials provided to all participants. Our analysis suggests that while providing support for teachers does not positively affect their confidence to teach first aid in the classroom, this increased support does positively affect the first aid knowledge of students