Elsevier

Resuscitation

Volume 37, Issue 1, 1 April 1998, Pages 13-20
Resuscitation

Factors surrounding cardiopulmonary resuscitation influencing bystanders' psychological reactions

https://doi.org/10.1016/S0300-9572(98)00027-6Get rights and content

Abstract

The incidence of Sweden's out-of-hospital cardiac arrests averages 10 000 annually. Each year bystanders initiate cardiopulmonary resuscitation (CPR) approximately 2000 times prior to arrival of emergency medical service (EMS). The aim of this study was to identify factors influencing the bystanders psychological reactions to performing CPR. We mailed a questionnaire to all bystanders who reported performing CPR to the CPR Centre of Sweden from autumn 1992 to 1995. The study included 544 bystander reports. Nine factors were found to be associated with bystanders experience in a univariate analysis. Among these were victim outcome (p<0.0001), CPR duration (p=0.0009) and their experience of the attitude of the EMS personnel (p=0.004). In a multivariate logistic regression model, lack of debriefing following the intervention (p=0.0001) and fatal victim outcome (p=0.03) were independent predictors of a negative bystander psychological reaction. The importance of having someone to talk to following an intervention and the EMS personnel concern for the rescuer should be emphasised. The goal should be that critical incident debriefing is available to every bystander following his or her CPR attempt.

Introduction

Most deaths from ischaemic heart disease occur outside hospital and are mainly due to ventricular fibrillation [1]. During the past two decades researchers have launched a huge effort to improve the prognosis of this population 1, 2, 3, particularly to strengthen each link in the `chain of survival': early access, early cardiopulmonary resuscitation (CPR), early defibrillation and early advanced life support [4]. Every link in the chain has an important effect upon overall care and outcome of these patients.

Sweden and many other countries have initiated community education programs targeted toward strengthening the second link in the chain of survival: early CPR. Sweden's community programs started in 1984 and there are currently about 1.5 million rescuers trained in CPR throughout the country. With a population of approximately 8.8 million this means that one out of every five Swedes have received CPR training.

Sweden's out-of-hospital cardiac arrest incidence averages 10 000 per year. Each year bystanders initiate CPR approximately 2000 times before the arrival of the emergency medical service (EMS), which means approximately five bystander CPR attempts occur daily (unpublished data from the Swedish Cardiac Arrest Registry (SCAR)). At least four out of five CPR attempts fail to save the life of the victim i.e. four out of five times lay responders find their heroic efforts unsuccessful. Most CPR interventions occur in public places such as the street 5, 6and on people unknown to the rescuer [7].

There is a great deficiency in our knowledge of the bystanders' reaction to their interventions. One reason for this is that bystanders are difficult to identify. A strength in the Swedish CPR system is the CPR event reporting card attached to every CPR course certificate. We have previously published a description of the experiences of the bystanders from over 700 reports [7]. We found that over 90% regarded their intervention as a `mainly positive' experience. Almost every responder indicated they would start CPR again, if required. However, 3% regarded their intervention as a `negative' experience. 4% described their reaction as `both negative and positive'. The purpose of this study was to identify the factors influencing the psychological reactions to performing CPR during an actual emergency reported by the bystanders.

Section snippets

Participants

We surveyed all CPR bystanders who reported a resuscitation attempt between autumn 1992 and 1995 using a card issued after their CPR training. The CPR Centre of Sweden received 758 reporting cards during this period and mailed each respondent a questionnaire. 175 (23%) bystanders who reported CPR did not return the questionnaire. Of 583 returned questionnaires we excluded 39 (7%) from this analysis due to reasons described below. This study reports data from the remaining 544 questionnaires,

Bystander characteristics and intervention setting

Of the total 544 responders, 273 were men. The mean age of the bystanders was 36 years, with a range of 16–72 years; 32% were hospital or EMS personnel; 36% of bystanders reported completing only one CPR course.

Most reports came from CPR performed in public places. Less than 20% of the interventions took place at home; 36% of the bystanders were related to or knew the victim; 76% were witnessed events.

Victim characteristics and outcome

The victim was most often male (76%) and 50–80 years old (60%). Age varied from <1 to >80.

Discussion

Previous studies report that cardiac arrests in public settings have an increased chance of survival when compared to surviving a collapse in the home [6]. It is possible that this improved survival relates directly to the fact that in public places the arrest is more likely to be witnessed and early CPR is more likely to be started. Inevitably when a bystander suddenly confronts death and reacts by performing their CPR skills during their daily routine strong emotional reactions arise.

In this

Acknowledgements

We acknowledge the bystanders, who endeavoured to save the life of a fellow human being. Financial support: Laerdal Foundation for Acute Medicine, Parke-Davis Scandinavia AB.

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