Validity of ICU Clinician's Appraisal of Proportionality in CPR

The VICAP-CPR study investigates whether doctors and nurses working in Intensive Care can determine neurological outcome and future quality of life after six months in patients treated for cardiac arrest outside the hospital based on clinical assessment in the first 24 hours after admission to Intensive Care. To conduct this study, the results of the questionnaire offered to Intensive Care doctors and nurses regarding the estimation of long-term neurological outcome and quality of life will be compared with the neurological outcome and quality of life as recorded in the STEPCARE study (NCT 05564754). The aim of the international STEPCARE study is to determine the best combination of post-resuscitation care to favourably influence survival and neurological outcome in patients treated for cardiac arrest outside hospital.

In the guidelines 2021 of the European Resuscitation Council it is acknowledged that apart from criteria related to the cardiac arrest circumstances, additional criteria can be used to support resuscitation decisions. For instance, the presence of severe chronic comorbidities or a very poor quality of life prior to cardiac arrest are allowed to support decisions to stop or not start resuscitation in unwitnessed out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm. In current clinical practice, these factors are often not taken into account and patients with severe underlying comorbidities and poor general condition are also resuscitated. In intensive care, a wait-and-see approach is then usually adopted until additional information is gathered about the patient's likely prognosis based on repetitive clinical neurological examination, electrophysiological tests such as electro-encephalography and somatosensory evoked potentials, biomarker analysis and cerebral imaging (multimodal neuroprognostication). At the ICU level, both physicians and nurses can have valuable insights into what the likely prognosis is of the OHCA patients they are treating. In subgroups with a poor prognosis (e.g. non-shockable unwitnessed arrest in older patient) the added value of the multimodal ICU neuroprognostication is potentially very limited or absent. The implication for intensive care could be that policy decisions could perhaps be made earlier in several situations. Exploring the prognostic value of the clinical perception of ICU physicians and ICU nurses regarding appropriateness of CPR and their prognostication of neurological outcome and quality of life relative to multimodal ICU neuroprognostication might help to refine the ethical guidance towards resuscitation decision making and towards ICU management after ROSC in general. The study aims are: 1. To assess whether and to what extent the following factors are associated with ICU clinician's perception regarding appropriateness of CPR: perceived presence of frailty, poor quality of life and severe comorbidities, as well as objective factors related to the OHCA (shockable rhythm, bystander CPR, witnessed arrest) and clinician characteristics (age, gender, years of experience and professional background). 2. To assess the concordance between clinicians' combined perception of inappropriateness of CPR (i.e. whether or not at least 2 clinicians perceive CPR as inappropriate) and multimodal ICU neuroprognostication as performed in STEPCARE. The STEPCARE trial is an international, investigator-initiated, randomised trial on three different aspects of standard care after out-of-hospital cardiac arrest. In a 2x2x2 factorial design the effect of continuous sedation vs. minimal sedation, fever management with a device vs. without a device and a higher blood pressure target vs. a lower blood pressure target are compared. The primary outcome of the trial will be survival at 180 days with secondary Покажи пълното описание...

Inclusion Criteria: * Doctors and nurses working in the Intensive Care Unit treating patients included in the STEPCARE study (NCT 05564754) Exclusion Criteria: * Doctors and nurses who do not have a direct treatment relationship with a patient included in the STEPCARE study