Clinical experience and skills of physicians in hospital cardiac arrest teams in Denmark: a nationwide study

Abstract

Background: The quality of in-hospital resuscitation is poor and may be affected by the clinical experience and cardiopulmonary resuscitation (CPR) training. This study aimed to investigate the clinical experience, self-perceived skills, CPR training and knowledge of the guidelines on when to abandon resuscitation among physicians of cardiac arrest teams.

Methods: We performed a nationwide cross-sectional study in Denmark. Telephone interviews were conducted with physicians in the cardiac arrest teams in public somatic hospitals using a structured questionnaire.

Results: In total, 93 physicians (53% male) from 45 hospitals participated in the study. Median age was 34 (interquartile range: 30-39) years. Respondents were medical students working as locum physicians (5%), physicians in training (79%) and consultants (16%), and the median postgraduate clinical experience was 48 (19-87) months. Most respondents (92%) felt confident in treating a cardiac arrest, while fewer respondents felt confident in performing intubation (41%) and focused cardiac ultrasound (39%) during cardiac arrest. Median time since last CPR training was 4 (2-10) months, and 48% had attended a European Resuscitation Council (ERC) Advanced Life Support course. The majority (84%) felt confident in terminating resuscitation; however, only 9% were able to state the ERC guidelines on when to abandon resuscitation.

Conclusion: Physicians of Danish cardiac arrest teams are often inexperienced and do not feel competent performing important clinical skills during resuscitation. Less than half have attended an ERC Advanced Life Support course, and only very few physicians know the ERC guidelines on when to abandon resuscitation.

Keywords: Advanced Cardiac Life Support; cardiopulmonary resuscitation; graduate medical education; resuscitation orders.

Figure 1

Characteristics of physicians in cardiac arrest teams (N=93). Notes: Full line: median; dashed line: 1st quartile and 3rd quartile. (A) Physicians’ age. Median age was 34 (30–39) years. (B) Physicians’ clinical experience. Median postgraduate clinical experience was 48 (19–87) months. The clinical experience of six physicians (336, 342, 348, 360, 408 and 444 months, respectively) is not shown in the figure. (C) Total count of cardiac arrests treated per physician. Median number of cardiac arrests treated was 20 (4–50). Six physicians reported to have treated 200 cardiac arrests and two physicians 1,000 cardiac arrests, which are not shown in the figure. (D) Physicians’ occupation and department allocation. Medical student (medical student working as locum physician; locum physician); house officer (physician with up to 1 year of postgraduate clinical experience); senior house officer (physician with >1 to ~3 years of postgraduate clinical experience); specialist registrar (physician in specialist training); consultant (board-certified specialist).