Abstract
Introduction
Guideline deviations with impact on patient outcomes frequently occur during in-hospital
cardiopulmonary resuscitation (CPR). However, barriers and facilitators for preventing
these guideline deviations are understudied. We aimed to characterize challenges occurring
during IHCA and identify barriers and facilitators perceived by actual team members
immediately following IHCA events.
Methods
This was a prospective multicenter clinical study. Following each resuscitation attempt
in 6 hospitals over a 4-year period, we immediately sent web-based structured questionnaires
to all responding team members, reporting their perceived resuscitation quality, teamwork,
and communication and what they perceived as barriers or facilitators. Comments were
analyzed using qualitative inductive thematic analysis methodology.
Results
We identified 924 resuscitation attempts and 3,698 survey responses were collected
including 2,095 qualitative comments (response rate: 65%). Most frequent challenges
were overcrowding (27%) and poor ergonomics/choreography of people in the room (17%).
Narrative comments aligned into 24 unique barrier and facilitator themes in 4 domains:
6 related to treatment (most prevalent: CPR, rhythm check, equipment), 7 for teamwork
(most prevalent: role allocation, crowd control, collaboration with ward staff), 6
for leadership (most prevalent: visible and distinct leader, multiple leaders, leader
experience), and 5 for communication (most prevalent: closed loops, atmosphere in
room, speaking loud/clear).
Conclusion
Using novel, immediate after-event survey methodology of individual cardiac arrest
team members, we characterized challenges and identified 24 themes within 4 domains
that were barriers and facilitators for in-hospital resuscitation teams. We believe
this level of detail is necessary to contextualize guidelines and training to facilitate
high-quality resuscitation.
Keywords
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Article info
Publication history
Published online: May 22, 2021
Accepted:
May 10,
2021
Received in revised form:
April 26,
2021
Received:
January 31,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
