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Table 8 Illustrative data excerpts

From: How senior paramedics decide to cease resuscitation in pulseless electrical activity out of hospital cardiac arrest: a mixed methods study

Theme Defining a futile resuscitation
Key features “things like age, rhythm, end tidal capnography, previous medical conditions and events preceding the event are probably some of the key factors I’d be thinking about.” (SP1)
A poor quality of life “quality of life I know there’s lots of controversy about should you use that as an indicator, but I find it useful to know in terms of if in the nicest possible way if the patients in a nursing home bedbound with severe dementia and comorbidities there’s something about should we be resuscing anyway.” (SP5)
A perceived natural end of life “I may feel more confident to say actually if it was an older person or more of the elder category then to consider that that might be their natural end of life.” (SP3)
Theme The impact of ceasing resuscitation
Confidence gained with experience and exposure “I am confident in making a decision yes I’ve been making it for enough years so I feel confident in making it…. is it always clear cut? No.” (SP5)
Critical awareness and self -reflection “I feel confident with my decisions but I do rethink every decision that I made remotely” (SP3)
The weight of responsibility when deciding futility “It did have its moments going about your daily business and you think bloody hell that is a bit hardcore so it’s very easy writing out a word document on your form and filling it in but when you actually put someone’s name in it and all their bits and pieces its quite oh actually someone just died and sometimes that was more stressful more poignant that being there.” (SP4)
Theme Perceived conflict between senior and on-scene paramedics
Senior paramedic/SCA? clinical knowledge, experience and accountability I don’t think crews have a great understanding of PEA they don’t necessarily know or fully understand the potential for reversible causes”. (SP2)
Clinical leadership and moral judgements “I would say that from my experience of it that you can make a decision with a degree of separation from what’s going on so you can take a reasoned history and then consider the factors without the background noise if you like and the human factors that come into play from a stressful on scene environment”. (SP4)
Conflict between senior and on-scene paramedic “They are trying to sell me a situation to fulfil their own agenda so their selling me a patient that’s profoundly unwell when there actually a survivable aspect to it because it is frustrating”. (SP4)
Theme Supportive tools for cessation of resuscitation decisions
The ‘checklist’ as a safety net “I think the fallback option which is used is just follow a checklist in order for safe practice.” (SP1)
Checklist deviation and sound clinical reasoning “Cessation of resuscitation checklist which we should use which helps govern our decision making……if a patient doesn’t fall within that then we have to be pretty confident and be very careful about calling a cessation of resuscitation attempt.” (SP1)
Checklist and moving forward “I do think the checklist that we are using is almost double negative in terms of the questioning and it’s still a little ambiguous in some areas.” (SP3)