Exploring cardiac arrest in 'at-home' settings: Concepts derived from a qualitative interview study with layperson bystanders

Stefanie Beck; Marc Phillipps; Antje Degel; Hans-Christian Mochmann; Jan Breckwoldt

doi:10.1016/j.resuscitation.2023.110076

Exploring cardiac arrest in 'at-home' settings: Concepts derived from a qualitative interview study with layperson bystanders

Resuscitation. 2024 Jan:194:110076. doi: 10.1016/j.resuscitation.2023.110076. Epub 2023 Dec 12.

Authors

Stefanie Beck¹, Marc Phillipps², Antje Degel³, Hans-Christian Mochmann⁴, Jan Breckwoldt⁵

Affiliations

¹ Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
² Department of Anaesthesiology, Benjamin Franklin Medical Center, Charité - University Medicine Berlin, Berlin, Germany.
³ Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
⁴ Dept. of Cardiology and Pulmology, Klinikum Garmisch Partenkirchen, Germany.
⁵ Department of Anaesthesiology, Benjamin Franklin Medical Center, Charité - University Medicine Berlin, Berlin, Germany; Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland. Electronic address: jan.breckwoldt@usz.ch.

PMID: 38092184
DOI: 10.1016/j.resuscitation.2023.110076

Abstract

Background: Two thirds of Out-of-Hospital Cardiac Arrests (OHCAs) occur at the patient's home ('at-home-CA'), where bystander CPR (B-CPR) rates are significantly lower than in public locations. Knowledge about the circumstances of this specific setting has mainly been limited to quantitative data. To develop a more conceptual understanding of the circumstances and dynamics of 'at-home CA', we conducted a qualitative interview study.

Methods: Twenty-one semi-structured in-depth interviews were performed with laypersons who had witnessed 'at-home CA'. The interviews were audio recorded, transcribed, and analysed by qualitative content analysis (QCA). A category system was developed to classify facilitating and impeding factors and to finally derive overarching concepts of 'at-home CA'.

Results: Qualitative Content Analysis yielded 1'347 relevant interview segments. Of these, 398 related to factors facilitating B-CPR, 328 to factors impeding, and 621 were classified neutral. Some of these factors were specific to 'at-home CA'. The privacy context was found to be a particularly supportive factor, as it enhanced the commitment to act and facilitated the detection of symptoms. Impeding factors, aggravated in 'at-home CA' settings, included limited support from other bystanders, acute stress response and impaired situational judgement, as well as physical challenges when positioning the patient. We derived six overarching concepts defining the 'at-home CA' situation: (a) unexpectedness of the event, (b) acute stress response, (c) situational judgement, (d) awareness of the necessity to perform B-CPR, (e) initial position of the patient, (f) automaticity of actions.

Conclusion: Integrating these concepts into dispatch protocols and layperson training may improve dispatcher-bystander interaction and the outcomes of 'at-home CA'.

Keywords: Bystander resuscitation; Cardiopulmonary resuscitation; EMS; Emergency dispatch; Out-of-hospital cardiac arrest.

MeSH terms

Cardiopulmonary Resuscitation* / methods
Emergency Medical Services*
Humans
Out-of-Hospital Cardiac Arrest* / therapy
Registries