Table 2 Study characteristics and critical appraisal score
From: Non-medical factors in prehospital resuscitation decision-making: a mixed-methods systematic review
Study (references) | Country | Aim of the study | Participants | n | Age | Gender | Experience | Quality assessment score % (Median (range)) |
|---|---|---|---|---|---|---|---|---|
Qualitative studies | ||||||||
Anderson et al. [8] | New Zealand | To identify the clinical, ethical, cognitive, and emotional challenges that emergency ambulance personnel experience when making decisions to commence, continue, withhold or terminate resuscitation | Ambulance personnel (first responder, EMT, paramedic, intensive care paramedic) | 16 | < 25–64 years | 8 male 8 female | 2–38 years Median: 12 years | 100 |
Anderson et al. [8] | New Zealand | To explore ambulance personnel’s decisions to commence, continue, withhold or terminate resuscitation efforts for patients with OHCA | Ambulance personnel (first responder, EMT, paramedic, intensive care paramedic) | 16 | < 25–64 years | 8 male 8 female | 2–38 years Median: 12 years | 100 |
Brandling et al. [23] | United Kingdom | To explore the influences on UK EMS provider decision-making when commencing and ceasing resuscitation attempts in OHCA | Paramedics | 16 | Median age: 40 years | 10 male 6 female | Median: 15 years | 80 |
Bremer et al. [24] | Sweden | To analyze EMS personnel’s experiences of caring for families when patients suffer cardiac arrest and sudden death | Specialist nurse (intensive care), paramedic (assistant nurse), prehospital emergency nurse, paramedic, specialist nurse (anesthesia) | 10 | 26–62 years | 6 male 4 female | < 1—> 20 years | 100 |
Davey et al. [25] | New Zealand | To highlight and explore underlying values present within practice-based decisions that focus on ADs | EMT, intermediate life support, and intensive care paramedic | 18 | 12 participants were aged > 30 years and four < 30 years | 13 male 4 female 1 undisclosed | > 3—> 10 years | 60 |
Karlsson et al. [26] | Sweden | To investigate Swedish specialist ambulance nurses’ experiences of ethical dilemmas associated with cardiac arrest situations in adult patients’ homes | Specialist ambulance nurses | 9 | 33–61 years Mean: 45.5 | 4 male 5 female | 5–17 years Mean: 11.5 | 100 |
Larsson et el. [27] | Sweden | To describe ambulance nurses’ experiences of nursing patients suffering cardiac arrest | Ambulance nurses | 7 | 35–52 years | 5 male 2 female | 2–6 years Median: 11 years | 100 |
Leemeyer et al. [5] | The Nether-lands | To identify factors that influence decision-making by prehospital EMS providers during resuscitation of patients with traumatic cardiac arrest | Ambulance nurses, HEMS nurses, and HEMS physicians | 25 | 39–48 years Median age: 43 | 18 male 7 female | 9–20 years Median: 12 years | 100 |
Lord et al. [28] | Australia | To describe outcomes of the first phase of a larger research project exploring the interface between paramedics and patients who require palliative care | Paramedics | 25 | The majority were aged under 40 years | 23 male 2 female | NA | 80 |
Naess et al. [29] | Norway | To elucidate the criteria used by the paramedics in the Oslo EMS system when making decisions about CPR and whether these criteria tended to differ from the criteria used by the doctors on the physician manned ambulance and if they were affected by the length of experience | Paramedics, residents, and staff anesthesiologists | 44 | NA | 41 male 3 female | 1—> 20 years | 0 |
Nordby et al. [30] | Norway | To understand how paramedics experience difficult ethical dilemmas regarding resuscitation of cancer patients | Paramedics | 15 | NA | NA | NA | 100 |
Nurok et al. [31] | United States France | To analyze the role of social, technical, medical or surgical, heroic, and competence values in the course of pre-hospital emergency work | Prehospital Emergency Services | NA | NA | NA | NA | 100 |
Quantitative studies | ||||||||
Druwé et al. [35] | Austria, Belgium, France, Germany, Netherland, Republic of Ireland, UK, Czech Republic, Hungary, Poland, Romania, Serbia, Slovak Republic, Cyprus, Greece, Spain, Finland, Iceland, Norway, Sweden, Chile, Israel, Japan, United States | To determine the prevalence of clinician perception of inappropriate CPR regarding the last OHCA encountered in an adult 80 years or older and its relationship to patient outcome | Doctors, nurses, and EMTs/paramedics | 611 | NA | NA | NA | 80 |
Druwé et al. [34] | Austria, Belgium, France, Germany, Netherland, Republic of Ireland, UK, Czech Republic, Hungary, Poland, Romania, Serbia, Slovak Republic, Cyprus, Greece, Spain, Finland, Iceland, Norway, Sweden, Chile, Israel, Japan, United States | To determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome | Doctors, nurses, and EMTs/paramedics | 4018 | NA | 2409 male 1609 female | NA | 80 |
Haidar et al. [36] | Lebanon | To examine the perspective of prehospital providers on resuscitation practices to inform and shape policy development related to resuscitation of OHCA victims in Lebanon | Prehospital providers (volunteers) | 258 | 18- > 40 years | 161 male 97 female | < 1—> 5 years | 80 |
Hick et al. [37] | United States | To determine the factors that influence the transport of OHCA patients and to define problems with field termination of resuscitation efforts | Paramedics | 259 | NA | NA | NA | 80 |
Johnson et al. [38] | United States | To examine occasions when EMTs do not initiate CPR according to their teaching or protocols. Furthermore, whether these situations troubled EMTs | EMTs | 310 | Mean age: 33.7 ± 8.2 years (SD) | 235 male 75 female | Mean: 7.3 ± 7.2 years (SD) | 100 |
Leibold et al. [39] | Germany | To detect whether or not religious and spiritual beliefs influence paramedics in their workday life concerning end-of-life decisions, and whether it is legally possible for them to act according to their conscience | Paramedics | 429 | Median age: 31 years | NA | Median: 8 years | 80 |
Meyer et al. [40] | Germany | To introduce a new methodological approach towards initiation and termination of resuscitation efforts in prehospital situations | Emergency physicians | 86 | Mean age: 33.9 | > 50% male | Mean: > 10 months | 60 |
Mohr et al. [41] | Germany | To determine, by questioning emergency physicians, the time interval within which resuscitative efforts are usually terminated and the importance attached to the different factors concerning the decision to abandon CPR attempts | Emergency physicians | 409 | NA | NA | < 1—> 5 years | 80 |
Navalpotro-Pascual et al. [42] | Spain | To explore the attitudes of the professionals that assist cardiopulmonary arrest in the face of these situations, and the factors that may influence them | Emergency physicians and nurses | 1000 (593 OH) | Median age: 42 years | 57% male 43% female | < 10—> 20 years | 80 |
Sam et al. [43] | United States | To identify factors that influence the behavior of EMS professionals in seeking and honoring ADs. It specifically examined potential barriers affecting the implementation of ADs by EMS professionals | EMS professionals and volunteers | 230 | 19–76 years Mean age: 35.2 | 70% male 30% female | NA | 80 |
Sherbino et al. [44] | Canada | To estimate how frequently EMT-Ds are forced to deal with prehospital DNACPR orders, to assess their comfort in doing so, and to describe the prehospital care provided to patients with DNACPR orders in a system without a prehospital DNACPR policy (i.e., where resuscitation is mandatory) | Emergency physicians | 221 | NA | NA | 1–30 years Mean: 14 years | 60 |
Stone et al. [45] | United States | To ascertain paramedics' attitudes toward end-of-life situations and the frequency with which they encounter them, and to compare paramedics' preparation during training for a variety of end-of-life care skills | Paramedics | 235 | 22–59 years Mean age: 39 years | 94% male 6% female | < 2—> 20 years | 60 |
Tataris et al. [46] | United States | To identify EMS providers’ perceived barriers to performing out-of-hospital TOR in a large urban EMS system | Firefighter/EMT-basic, firefighter/EMT-paramedic and single role paramedic | 2309 | NA | NA | Median: 16 years | 100 |
Mixed methods studies | ||||||||
de Graaf et al. [32] | The Netherlands | To determine differences between patients without ROSC to be transported vs. terminated on scene and explore medical and nonmedical factors that contribute to the decision-making of paramedics on scene | Paramedics | QUAL: 16 | Median age: 49 years | 10 male 6 female | > 1 years | 100 |
Waldrop et al. [33] | United States | To explore prehospital providers’ perspectives on how legally binding documents (nonhospital DNACPR order/medical orders for life-sustaining treatment) informed end-of-life decision-making and care | Resuscitation providers | QUAN: 239 QUAL: 50 | Mean age: 34.6 ± 11.8 (SD) | 77% male 23% female | NA | 20 |