Why Do Emergency Physicians not Follow International Guidelines on Adrenaline Administration in Cases of Cardiac Arrest?

摘要

Aims: The management of cardiac arrest is based on international guidelines which, in particular, define a specific adrenaline administration scheme. However, among physicians practicing pre-hospital emergency medicine, significant inter-individual variations in the use of adrenaline have been observed. The aim of this study was to identify the factors underlying this failure to conform to guidelines. Procedure: We have conducted a prospective, qualitative, multi-center study and held individual semi-structured interviews with emergency physicians. Following transcription, a thematic analysis of the interviews was performed. Results: Thirteen interviews were conducted. Failure to observe adrenaline administration guidelines was observed in 7 interviewed practitioners. The interviewees tended to explain these deviations by their desire to enhance the chances of successful resuscitation (leading them to increase the dose of the adrenaline boluses) or, at the end of resuscitation, to empty the syringe of adrenaline, administering a final bolus considered to be the patient's "last chance". Patient weight, co-morbidities and age could also lead to dosage adjustments, as could some factors inherent to practitioners such as their level of knowledge of the latest recommendations or their personal habits. Conclusion: There is significant variability in the use of adrenaline by emergency physicians in the pre-hospital management of cardiac arrest. These gaps in practice require the implementation of measures intended to promote observance of scientific guidelines.