Disability specific cpr and basic life supportA LITERATURE REVIEW, WHAT IS CURRENTLY AVAILABLE TO GUIDE PRACTICE AND EDUCATION? ELISHA DEEGAN

Disability is defined by the International Classification of Functioning and Health (ICF) as being an ‘umbrella term for impairments, activity limitations and participation restrictions.

18% of Australians – 5.7% with severe or profound limitation4.4% of people with a disability use a wheelchair

(Australian Bureau of Statistics (ABS) 2018, Australian Network on Disability 2019, Premiers Disability Advisory Council 2018, World Health Organisation (WHO) 2018)

Australian Bureau of Statistics (ABS) 2018, Australian Network on Disability 2019, Premiers Disability Advisory Council 2018, World Health Organisation (WHO) 2018)

ARC guidelines • BLS for general population - 39• ALS for Adults - 12• ALS for Paediatrics - 7• ALS for neonates – 10• Acute Coronary Syndromes - 5

‘What information is currently available to guide people in performing BLS for individuals with atypical chest shape or for those in wheelchairs?’

(ANZCOR 2017, Clayton & Ellis 2015)

Searches conducted

1. Resuscitation Council guidelines2. Hospital protocols, policies and

guidelines3. Databases for previous research

Resuscitation Councils SearchedAustralian Resuscitation Council – including members only literatureResuscitation Council of the United KingdomAmerican Heart AssociationInternational Liaison Committee on ResuscitationEuropean Resuscitation CouncilHeart and Stroke Foundation of CanadaResuscitation Council of South AfricaResuscitation Council of AsiaResuscitation Council of New Zealand

Hospitals SearchedMayo Clinic - USACleveland Clinic - USASingapore General Hospital SingaporeCharite Hospital – BerlinJohn Hopkins Medicine - USAMassachusetts General Hospital – USA Toronto General Hospital –CanadaUniversity of Tokyo Hospital –JapanLausanne University Hospital – SwitzerlandSheba Medical Centre –Israel

Children’s Hospitals Searched St Jude’s Children’s Research Hospital – USA St Louis Children’s Hospital – USA Monroe Carell Jn. Children’s Hospital – USA Birmingham Women’s and Children – UK Benioff Children’s Hospital – USA Royal Children’s Hospital – Australia National Centre for Child Health and Development – JapanDana-Dwek Children’s Hospital –IsraelThe Royal Belfast Hospital – Northern IslandHospital for Sick Kids – Canada (Miller 2019) (Stone 2016)

Author/year Country Type: document or study

Focus or sample* Level of evidence Relevant findings Comments

D.Pitcher (ed.) 2013

United Kingdom

Guideline Working group of 12 experts on manual handling

Level 5 Expert Opinion Guidance for safer manual handling during CPR including removal of patient from chair to floor

No provisions for complex wheelchair or atypical chest shape

S. Cash and A Shinnick-Page2008

United Kingdom

Discussion paper Expert opinion of 2 clinical skills lecturers

Level 5 Expert consensus

Discovered lack of guidelines to provide BLS to people with profound disabilities. Authors identified key areas for extension of learning, including locating sternum and correct place for compressions. Authors query the possibility of seated CPR similar to that used by airline staff. Authors propose extending additional BLS from the current Learning Disability Nursing students to all nursing student streams.

Authors where seeking input from colleagues regarding appropriateness of discussion points and further teaching.

A. Page and S. Cash2011

United Kingdom

Symposium report Symposium and opinion from colleagues, numbers attending not stated

Level 5 Expert consensus

Continuing lack of guidelines. High level of fear amongst health care staff when presented with scenarios involving patients with profound disabilities.

Identification that introduction of specific BLS and CPR could reduce mortality.

G. Sharrieff S. HostetterP. Silva2001

United States of America

Pilot Study Eighteen Foster parents of medically fragile children. Inclusion criteria: FFT, DD, CP, seizures, asthma and ventilator dependence

Level 2 pre-test-post-test control group study.

Importance of foster parents of medically fragile children to have individual CPR and Foreign body removal (FBR) lessons.Foster parents were taught standard CPR and FBR skills, all parents had current BLS certification. Confidence levels were self-rated.

FBR demonstration for children ≤ 1 year was most difficult prior to intervention. Teaching was applied 4 times in real life situation post intervention.

L. Knight S. WintchA. NicolsV. ArnoldeA. Schoreder2013

United States of America

Observational study

Families of 117 high risk children. Inclusion criteria: prem,neonates with apnoea or BC, solid organ transplant recipients, CHA, CHF, CM, life-threatening arrhythmias, patient’s recovering from cardiac surgery and patients with O2, ventilator, or tracheostomy

Level 3 Observational study without a control group

The provision of the CPR Anytime Kit™ to family’s with medically fragile children improved their retention of CPR knowledge, skills, comfort and confidenceOf the families participating 53% had previously undertaken CPR training.

The author’s definition of medically fragile did not include disabled

*FFT = Failure to thrive, DD = Developmental delay, CP = Cerebral Palsy, Prem = premature birth (< 37 weeks), BC = bradycardia, CHA = cyanotic heart disease, CHF = congestive heart failure, CM = cardiomyopathy O2 = Oxygen

(The Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party 2013)

Why do we need more research? What will it change?

(Fletcher et al. 2012)

Evidence in the literature of the need for improved guidelines.

• Ombudsmen reports• Avoidable deaths in disability• Not a localised issue

(Barbour 2007; Barnes 2018; Griffiths -Cook 2016; Mencap 2007)

The honours research

• Mixed methods pre test post test study

• Discussion and scenarios during BLS and CPR classes

• Determine if there is a relationship between increased education and confidence

• Initial data has been collected• Six month follow up

hascommenced

What are we doing so far?

• Embedded specific training into our standard First Aid and CPR classes

• Provided students with practical scenarios and equipment to test techniques on

• Using CPR Cubes /Randy / CPR Meter to give students feedback and a chance to test the techniques

Where to from here……..

Just because it does not exist does not mean that it can not

More research, more experimentation, more trials, more exposure, more work!

REFERENCES:

ANZCOR 2017, Guideline 1.3 – Process for developing resuscitation guidelines, The ARC Guidelines, < https://resus.org.au/guidelines/>.

Australian Bureau of Statistics (ABS) 2018, Collection and Interpretation of ABS Disability Data, <http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4431.0.55.002Main%20Features62012%20-%202016?opendocument&tabname=Summary&prodno=4431.0.55.002&issue=2012%20-%202016&num=&view=>.

Australian Network on Disability 2019, Disability Statistics, Australian Network on Disability, viewed 5/4/2019, <https://www.and.org.au/pages/disability-statistics.html>.

Barnes, M 2018, Report of Reviewable Deaths in 2014 and 2015 2016 and 2017 Deaths of people with disability in residential care, Sydney.

Clayton, S & Ellis, T 2015, 'Shaping the future', Learning Disability Today, vol. Nov/Dec, pp. 16-17.

Cash, S & Shinnick-Page, A 2008, 'Basic life support and children with profound and multiple learning disabilities', Paediatric Nursing, vol. 20, no. 2, pp. 38-39.

Fletcher, DJ, Boller, M, Brainard, BM, Haskins, SC, Hopper, K, McMichael, MA, Rozanski, EA, Rush, JE & Smarick, SD 2012, 'RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines', Journal Of Veterinary Emergency And Critical Care (San Antonio, Tex.: 2001), vol. 22 Suppl 1, pp. S102-S131.

Griffiths-Cook, J 2016, Upholdng the right to life and health: A review of the deaths in care of people with disabulity in Queensland, Queensland Government.

Knight, LJ, Wintch, S, Nichols, A, Arnolde, V & Schroeder, AR 2013, 'Saving a life after discharge: CPR training for parents of high-risk children', J Healthc Qual, vol. 35, no. 1, pp. 9-16; quiz17.

Miller, N 2019, The top 10 Hospitals in the World, Newsweek Magazine, <https://www.newsweek.com/2019/04/05/10-best-hospitals-world-1368512.html >.

Page, A & Cash, S 2011, 'Basic life support for people with profound and multiple learning disabilities’', Learning Disability Practice, vol. 14, no. 6, pp. 28-30.

Pitcher, D (ed.) 2013, Guidance for safer handing during resuscitation in healthcare settings, London, viewed 24/3/2019, <https://www.resus.org.uk/publications/guidance-for-safer-handling-during-cpr-in-healthcare-settings/>.

Premiers Disability Advisory Council 2018, Accessible Island Disability Framework for Action 2018-2021, Tasmania.

Sharieff, GQ, Hostetter, S & Silva, PD 2001, 'Foster parents of medically fragile children can improve their BLS scores: results of a demonstration project', Pediatr Emerg Care, vol. 17, no. 2, pp. 93-95.

Stone, I 2016, 30 Most Technologically Advanced Children’s Hospitals in the World’, Top Masters in Healthcare Administration, viewed 12/4/2019, < https://www.topmastersinhealthcare.com/30-most-technologically-advanced-childrens-hospitals-in-the-world/>.

The Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party 2013, New Joanna Briggs Institute Levels of vidence The Joanna Briggs Institute, viewed 13/5/2019, <http://joannabriggs.org/assets/docs/approach/JBI-Levels-of-evidence_2014.pdf>.

Wienroth, M, Caffrey, L, Wolfe, C & McKevitt, C 2018, 'Patient-initiated recruitment for clinical research: Evaluation of an outpatient letter research statement', Health Expectations, vol. 21, no. 2, pp. 494-500.

World Health Organisation (WHO) 2018, Disability and Health, World Health Organisation, viewed 23/4/2019, <https://www.who.int/en/news-room/fact-sheets/detail/disability-and-health>.