Clinical practice guidelines for resuscitation in acute care hospitals
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Published on: January 30, 2020
1Department of Cardiopulmonary Sciences, Northeastern University, Boston, MA 02115, USA.
Insights
Respiratory care practitioners (RCPs) should enhance their roles in cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) teams. Guidelines aim to improve resuscitation outcomes, focusing on patient quality of life and appropriate use of do-not-resuscitate (DNR) orders.
Area of Science:
- Cardiopulmonary Resuscitation (CPR)
- Emergency Cardiac Care (ECC)
- Clinical Practice Guidelines (CPGs)
Background:
- The American Heart Association (AHA) and American Association for Respiratory Care (AARC) are developing guidelines for CPR and ECC.
- Registered Care Practitioners (RCPs) with Advanced Cardiac Life Support (ACLS) training are well-positioned to lead in-hospital resuscitation efforts.
- Current RCP competence in ACLS needs assessment to optimize team performance.
Purpose of the Study:
- To highlight the critical role of RCPs in improving in-hospital resuscitation team performance.
- To emphasize the need for clear goals in resuscitation, considering long-term survival and quality of life.
- To address the financial and ethical implications of inappropriate Do-Not-Resuscitate (DNR) orders.
Main Methods:
- Review and integration of AHA Guidelines for CPR and ECC.
- Review and integration of AARC RACH Clinical Practice Guideline.
- Analysis of the impact of disease categories on CPR outcomes.
Main Results:
- RCPs are integral to resuscitation teams, contributing to overall performance and ACLS training.
- Defining resuscitation goals must include patient-centered outcomes like quality of life and long-term survival.
- Individualized assessment for DNR orders is crucial, considering patient perception and medical futility.
Conclusions:
- Adherence to AHA and AARC guidelines can significantly improve resuscitation team effectiveness.
- RCPs should be proactive in ACLS training and team leadership.
- Patient quality of life and disease-specific outcomes must guide decisions regarding resuscitation and DNR orders, acknowledging the limitations of medical technology.
Abstract:
The development of the AHA Guidelines for CPR and ECC and the AARC RACH Clinical Practice Guideline should both be instrumental in improving the performance of RCPs on in-hospital resuscitation teams. The AARC and AHA are assuming important leadership roles in this movement by publishing CPGs for CPR and ECC. RCPs with ACLS training are in a prime position to assume more responsibility on resuscitation teams within acute care facilities. They should be prominent members of the resuscitation team--committed to the entire team's performance--and be actively involved in ACLS training. The first step in that process is to study the current levels of RCP competence in ACLS. Further, RCPs and health-care providers should define the goals of resuscitation in terms of long-term survival, quality of life, and years of useful life after CPR. The cost of inadequate attention to which patients should have DNR orders is a drain on the entire health-care system. Research on the impact of disease categories on CPR outcome should be used to educate physicians, nurses, and RCPs so they can help patients better understand their chances of regaining their pre-CPR quality of life. Successful CPR outcome should be carefully defined using the patient's disease category. Each patient should be individually evaluated for DNR orders. As suggested by Schwenzer, "Patients' perception of their quality of life before and after CPR should guide their and our decisions." However, we must all accept the responsibility for defining the limitations of medical technology and try to determine when CPR is futile.
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