Abstracts / Resuscitation 85S (2014) S15–S121 S83

ethic lecture. Regarding the country values, lectures must aim toinform and direct the candidates accompanied with scientific andlegal realities.

Age:Gender:Profession:Years of profession:Your geographical region:Your institution:Your unit:Religion:a) Muslim b) Christian c) Jewish d) Atheist e) Others:

1. Do you know what is meant by the concept of “Do Not Resus-citate”?a) Knowb) Don’t knowc) Partly Know

2. Do you agree with the concept of “Do Not Resuscitate”?a) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

3. Decision of “Do Not Resuscitate” should only be made by physi-ciana) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

4. Decision of “Do Not Resuscitate” should be made by patienta) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

5. Decision of “Do Not Resuscitate” should be made by phsicianand patient togethera) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

6. Age is a factor in “Do Not Resuscitate” decisiona) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

7. Decision of “Do Not Resuscitate”, only limits the life savinginterventions during CPRa) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

8. Do you have information about the legal aspects of “Do NotResuscitate” decision?a) Knowb) Don’t knowc) Partly Know

9. Decision of “Do Not Resuscitate” is legal in our countrya) Knowb) Don’t knowc) Partly Know

10. Personal values determines the decision of “Do Not Resuscitate”

a) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

11. Personal belief determines the decision of “Do Not Resuscitate”a) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

12. Personal experiences determines the decision of “Do Not Resus-citate”a) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

13. Personal expectations determines the decision of “Do NotResuscitate”a) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

14. Decision of “Do Not Resuscitate” should not affect the othermedical interventions suitable for patienta) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

15. CPR applied patients can be organ donora) Certainly disagreeb) Disagreec) Undecidedd) Agreee) Certainly agree

Further reading

1. P R Health Sci J 2010;29:96–101.2. Resuscitation 2005;64:71–7.

http://dx.doi.org/10.1016/j.resuscitation.2014.03.207

Implementation

AP159

“Getting resus at the forefront”: A qualitativestudy of the mechanisms of cardiac arrestdebriefing

Keith Couper 1,∗, Frances Griffiths 2, Gavin D.Perkins 2

1 Heart of England NHS Foundation Trust,Birmingham, UK2 Warwick Medical School, University of Warwick,Coventry, UK

Background: Cardiac arrest debriefing is associated withimproved CPR (cardiopulmonary resuscitation) delivery.1 As acomplex intervention,2 it seems likely that cardiac arrest debrief-ing affects a number of behaviours, but the exact mechanisms bywhich it works are poorly understood. The aim of this study was

S84 Abstracts / Resuscitation 85S (2014) S15–S121

to develop an understanding of the mechanisms by which cardiacarrest debriefing impacts on practice.

Methods: Tape-recorded semi-structured interviews wereundertaken with clinicians, stratified for professional role, whohad experience of cardiac arrest debriefing following their involve-ment at a cardiac arrest. In addition, field notes were collected ofdebriefing meetings and other events during the study period. Datawere inputted in to NVivo computer software (NVivo Version 10,QSR International, Victoria, Australia). Following a period of dataimmersion, data were thematically analysed. This work was a sub-study of the CPR Quality Improvement Initiative study.3

Results: Thirteen semi-structured interviews and 41 sets offield notes were thematically analysed. Four emergent themeswere identified: the impracticality of debriefing; the individual andfeedback- managing the ‘ego’; finding solutions through discus-sion; and the cultural effect of cardiac arrest debriefing. Findingswere used to develop a model. The model describes six keymechanisms (reflection on performance; vicarious learning; psy-chological benefit; opening up the feedback process; moderatingthe use of assistive technologies; and altered perception of car-diac arrest) that exert an effect through two modalities (discussionwith colleagues and feedback on performance). For debriefing to beeffective, the process must be underpinned by a no-blame culture.

Conclusion: Cardiac arrest debriefing is a complex interven-tion that can affect cardiac arrest performance through six distinctmechanisms, via two key modalities. Different models of debrief-ing may affect modalities to varying extents, which may alter theeffectiveness of these debriefing approaches.

References

1. Couper K, Salman B, Soar J, et al. Intensive Care Med 2013;39:1513–23.2. Craig P, Dieppe P, Macintyre S, et al. Developing and evaluating complex inter-

ventions: new guidance. Medical Research Council; 2008.3. Perkins GD, Davies RP, Quinton S, et al. Scand J Trauma Resusc Emerg Med

2011;19:58.

http://dx.doi.org/10.1016/j.resuscitation.2014.03.208

AP160

Clinician perceptions of the usefulness ofcardiac arrest debriefing: A questionnaire study

Keith Couper 1,∗, Mehboob Chilwan 1, AnnalieBaker 1, Robin P. Davies 1, Frances Griffiths 2,Gavin D. Perkins 2

1 Heart of England NHS Foundation Trust,Birmingham, UK2 Warwick Medical School, University of Warwick,Coventry, UK

Background: The way in which clinicians perceive cardiacarrest debriefing may impact on its effectiveness. A recent system-atic review identified a lack of data on how clinicians view cardiacarrest debriefing.1 The aim of this study was to describe clinicianresponses to cardiac arrest debriefing.

Methods: We delivered weekly cardiac arrest debriefing meet-ings as part of the CPR Quality Improvement Initiative study.2

Two short paper-based questionnaires were developed. Question-naire one evaluated clinician’s immediate response to debriefing.Questionnaire two assessed the subjective effect of debriefingon knowledge and practice. Clinicians were eligible to completequestionnaire one every time they attended a meeting. Clinicianscompleted questionnaire two once only. Questionnaires containedboth Likert-style and free-text questions. Data were analysed usingSPSS (SPSS v21.0, IBM, New York, USA).

Results: Between November 2011 and May 2013, 74 debriefingmeetings were held. 323 clinicians attended. Most only attendedone meeting (n = 208, 64.40%). Mean attendance per meeting was12.59 ± 4.67 (range 3–24). Questionnaire one was distributed at 45meetings between May 2012 and May 2013. 375 questionnaireswere completed (response rate: 65.56%). Most respondents agreedor strongly agreed that meetings were relevant to clinical practice(n = 364, 97.07%), that that they felt comfortable contributing todiscussions (n = 337, 90.35%), and would recommend meetingsto others (n = 368, 98.66%). Questionnaire two was distributed atnine meetings. Forty-nine responses were received (response rate:63.64%). Most respondents agreed or strongly agreed that theirknowledge (87.76%, n = 43), confidence (73.47%, n = 36), and clinicalpractice (77.55%, n = 38) improved as a result of attending debrief-ing meetings.

Conclusion: In this study, clinicians described cardiac arrestdebriefing as clinically relevant, and reported that it had a positiveimpact on knowledge, practice and confidence.

References

1. Couper K, Salman B, Soar J, et al. Intensive Care Med 2013;39 9:1513–23.2. Perkins GD, Davies RP, Quinton S, et al. Scand J Trauma Resusc Emerg Med

2011;19:58.

http://dx.doi.org/10.1016/j.resuscitation.2014.03.209

AP161

Refractory cardiac arrest: Do we go beyond, dowe increase the organ donation pool or both?

Ivan Ortega 1,2,3,4,∗, Edurne de la Plaza 1,2,3,4

1 HEMS SUMMA 112, Madrid, Spain2 Montreal Children’s Hospital, Montreal, Canada3 Alcala de Henares University, Madrid, Spain4 The Bertram Loeb Chair in Organ Donation,Ottawa, Canada

Background: According with the last updated guidelines onresuscitation, the underlying cause of cardiac arrest (CA) shouldbe identified, treated and, if possible, reversed. This target isseeked for various pioneering programs worldwide with differentstrategies: extracorporeal cardiopulmonary resuscitation (ECPR),percutaneous coronary intervention (PCI) under ongoing resusci-tation and intra-arrest cooling (hypothermia). All these procedureshave a common target: to increase long-term survival outcomesof CA with good neurologic recovery. On the other hand, somecountries have implemented programs for uncontrolled donationafter circulatory determination of death (uDCDD), after consideringthe irreversibility of cardiac arrest and/or futility of resuscitationattempts. Both strategies are complementary and should coexist.A comprehensive approach to the refractory CA takes into accountthe specific event, the means available and the case-by-case cir-cumstances of the patient. Thus, we would be able to go beyondthe refractory CA firstly and, if not indicated, secondly we couldincrease the organ donation pool after confirming the irreversibilityof CA.

Purpose of the study: To address the following question: Is pos-sible to improve the current standard of treatment owed to victimsof refractory CA before including them in an uDCDD program? Thisstudy aims to match both strategies seeking for a better survivaloutcome of refractory CA and, when not possible, raising the avail-ability of vital organs for transplantation, reducing the growingwaiting lists in a worldwide organ shortage trend

Materials and methods: A literature review of protocolsapproaching the refractory CA with these techniques and therapies: