A Critical Evaluation of Studies about Cardiopulmonary Resuscitation - Literature review Example

Cardiopulmonary resuscitation is a therapeutic medical modality with both indications and counter indications (Prado et al, 1990; ILCOR, 2000). Although frequently performed in the hospital, its efficacy has not been well established in these environments where many seriously ill patients are found who have multisystem afflictions and a poor prognosis. Inappropriate resuscitation measures may result in increased financial and emotional costs and little or no benefits to the patient. Forty years ago, when methods of closed chest cardiac massage were described by Kouwenhoven et al as a means to resuscitate hearts that stopped beating, the intent was to use the procedure for sudden unexpected cardiac arrests in patients who were otherwise in good physiological condition. Kouwenhovens method of closed-chest cardiac compression improved the outcome of cardiopulmonary resuscitation (CPR) dramatically. In his first report of 20 patients undergoing CPR, Kouwenhoven had a 70% success rate (survival up to discharge). During the 40 years since the introduction of modern cardio-pulmonary resuscitation (CPR), there have been many advances in the field of emergency cardiovascular care (ECC). Contrary to Kouwenhoven’s report, recent research has shown that people who experience traumatic cardiac arrest rarely survive outside the hospital. If the person has suffered blunt trauma, cardiac arrest prior to reaching the hospital carries a 99% mortality rate in spite of ongoing efforts at resuscitation after arrival at the hospital(Perina, 2005). Approximately 1% to 6% of patients suffering out-of-hospital cardiac arrest ultimately survive the event, and although survival rates are somewhat better for in-hospital arrest patients, a recent comprehensive report observed that only 17% of these patients were discharged alive( Engdahl J,2002) Unsatisfactory results of cardiopulmonary resuscitation procedures have for the most part attributed to its indiscriminate use. Various individual factors interfere with recovery from cardiopulmonary arrest. Despite the fact that the prediction of an individual outcome of such resuscitation is of great medical, ethical, and socio-economic interest, doubts about the decision whether or not to resuscitate a given patient, as well as about the consequences of either attitude, persist (Rogov, 1995). This decision should not be made only at the moment of cardiopulmonary arrest, but should also take the previous medical condition of the patient into account (Landry, 1992). Cardiopulmonary resuscitation is frequently performed in stressful situations. Persons providing this treatment frequently fail to consider the possibility that the patient may have a cardiac disease in its final phase, taking into account only that cardiopulmonary arrest is an emergency situation (Roberts et al, 2000). Although there has always been a lot of emphasis on the spontaneity, available resources and the delivery of adequate medical care to patients who present with cardiac arrest, not much has been said and done about the “quality” of CPR administered to these patients in a hospital settings which is undoubtedly the primary factor affecting survival outcome. There is a definite need to assess weather the procedure delivered by health care personnel is in compliance with international published guidelines. Benjamin et al (2005) conducted a study in this respect and measured the chest compression rates during CPR in three hospital settings using a validated handheld recording device that provided readily quantifiable metric (chest compression rate) as a surrogate measure for CPR quality. Resuscitation guidelines published in the United States and Europe recommend that chest compressions be performed at a rate of 100 compressions per minute (cpm). The study was conducted at three study centers over a one year period with the help of investigation teams consisting of trained observers. Trained observers were registered nurses or respiratory therapists (LGH). This could be a confounding factor in the study as the chosen centers are in most probability tertiary care hospital with the most highly trained staff in the area. This is likely to over-estimate the results as the quality of CPR administration is overlooked in smaller clinical settings and by local physicians. All observers were previously certified in basic life support and had prior experience in cardiac resuscitation and received intensive training with respect to the validation of the protocol by practicing on a videotape showing simulated arrest of known compression rates. However, Inter- observer and intra-observer variation in handling of the assessment tool is likely to occur in real-life setting which could also produce a bias in the results. To counteract this bias, data recorded by the observers was validated and the mean correlation coefficient was found to be 0.95 indicating that the degree of variability was not very significant and the data recorder was reliable and reproducible. Furthermore, cases were excluded if the patients experiencing arrest were Read More