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Patients and the public appear to significantly overestimate the success of cardiopulmonary resuscitation (CPR), potentially affecting issues around consent, according to US researchers.
In contrast, people tend to underestimate the negative impact CPR can have on health of those who have received it, said study authors in Emergency Medicine Journal.
“Patients and visitors to an emergency department, regardless of prior healthcare or CPR experience, overestimate the likelihood of success with CPR”
Perhaps unsurprisingly, they found that the representation of CPR on television appeared to be the main driver of these perceptions.
As a result, the researchers recommended clinicians discuss CPR with patients and their relatives to clarify its success rate, and the benefits and risks involved, before they were asked to consent to it.
The researchers noted that preconceptions about CPR could have a significant effect on the tone of discussions with patients and relatives about end-of-life care and outcomes of resuscitation efforts.
They said previous studies suggested most people overestimated CPR success and underestimated morbidity, but none had been carried out among patients and visitors in an emergency department.
Patients in these earlier studies had cited television as a large source of their belief that survival rates after CPR varied between 19% and 75%, said the researchers.
In reality, actual rates of survival of CPR range from an average of 12% for out-of-hospital cardiac arrests to 24–40% for in-hospital arrests, they said.
As a result, the University of California researchers surveyed 500 adults waiting in an accident and emergency department.
The survey asked about their expectations and assessed whether or not variation in information sources, prior exposure to CPR, and healthcare experience would influence their predicted CPR success rates.
Results showed that, of the 500 respondents, 53% had performed or witnessed CPR, but television was the main source of information about CPR for around 95% of respondents.
At least half of the people interviewed estimated the success rate of CPR as being more than 75% in all situations, unrelated to their age, sex, race, spiritual beliefs or personal healthcare experience.
Meanwhile, the vast majority of people, 90%, interviewed said they wanted to receive CPR if it was possibly needed, the survey found.
“When discussing CPR preferences, emergency department providers should focus on true rates of survival and outcomes”
The researchers concluded: “Patients and visitors to an emergency department, regardless of prior healthcare or CPR experience, overestimate the likelihood of success with CPR.”
They said the “findings should prompt” A&E clinicians to initiate discussions about resuscitation with their patients while also providing them with key information to help informed decision-making.
“When discussing CPR preferences, emergency department providers should focus on true rates of survival and outcomes in any shared decision-making conversation,” they said.
They added that discussions “should not assume that a patient or companion with healthcare experience will have realistic expectations”.