In 2014, the authors conducted a survey of key opinion leaders on ethical resuscitation practices in 31 European Countries. The authors administered a comprehensive questionnaire to 1-2 "experts" from each country; subjectivity-related bias could not be excluded; however, the questionnaire was actually administered twice over a 6-month period to all participants, in order to confirm results' reproducibility. The questionnaire spanned across the following 4 domains: A: ethical practices (41 questions); B: access to best available care (39 questions); C: death diagnosis and organ donation (22 questions); and D: emergency care organization (40 questions). Accordingly, a 142-point scoring system of the responses of the participants was developed. Country-specific scores varied widely \[e.g. score range of 1-41 for the ethical practices (domain A), and of 9-32 for emergency care organization (domain D)\]. The authors also found a significant association between domain A and domain D scores (r2 = 0.42, P \< 0.001). The results of the 2014 survey highlighted variability across European countries in their approach to the ethics of resuscitation/end-of-life care. Results also indicated the presence of substantial need for improvements in all the aforementioned domains of practice and emergency care organization On the other hand, such evolution should be substantially augmented and accelerated by the above-described combination of new guidelines, RCT-based support of ACP, legislation / governmental policies, and educational activities. With this study the authors undertake a methodologically improved version of the 2014 survey, in order to test the following hypotheses: 1) compared to 2014, there may be significant improvements in overall domain A to D scores for 2019, reflecting improved quality of ethical practice in the field of resuscitation/end-of-life care; 2) such progress, may be more marked in countries with "low" (i.e. below-average) domain A to D scores for 2014.
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END-OF-LIFE PRACTICES
Timeframe: Within one year of occurrence of cardiac arrest or need for treatment of an acute illness
END-OF-LIFE DECISIONS
Timeframe: Within one year of occurrence of cardiac arrest or need for treatment of an acute illness
Family presence during Cardiopulmonary Resuscitation (CPR)
Timeframe: Wtihin 6 hours of onset of cardiac arrest
ACCESS TO BEST RESUSCITATION AND POSTRESUSCITATION CARE
Timeframe: Within 10 days of onset of cardiac arrest
DIAGNOSIS OF DEATH AND ORGAN DONATION
Timeframe: Within 60 min of cessation of resuscitaiton efforts
Organ donation
Timeframe: Within 24 hours of surgical harvesting of organs
EMERGENCY CARE: Access to resuscitation care in case of cardiac arrest in different areas / settings
Timeframe: Within 60 min of onset of cardiac arrest
EMERGENCY CARE: Defibrillation
Timeframe: Within 60 min of onset of cardiac arrest
EMERGENCY CARE: Level of care provided by out-of-hospital emergency services
Timeframe: Within 60 min of onset of cardiac arrest
Organization of in-hospital resuscitation services
Timeframe: Within 24 hours of onset of cardiac arrest
EMERGENCY CARE: Registry reporting of cardiac arrest
Timeframe: Within 24 hours of onset of cardiac arrest
EMERGENCY CARE: Education
Timeframe: Within the preceding and subsequent 5-year period
EMERGENCY CARE: Enrollment in Emergency Research and Informed Consent
Timeframe: Within 4 hours of onset of cardiac arrest