Concept Analysis of Cardiac Arrest: Identifying the Critical Attributes and Empirical Indicators

Kang Im Lee; Hyun Soo Oh

doi:10.7475/kjan.2014.26.5.573

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Concept Analysis of Cardiac Arrest: Identifying the Critical Attributes and Empirical Indicators

Kang Im Lee¹, Hyun Soo Oh²

Korean Journal of Adult Nursing 2014;26(5):573-583.
Published online: October 31, 2014

DOI: https://doi.org/10.7475/kjan.2014.26.5.573

¹Surgical Intensive Care Unit, Inha University Hospital, Incheon

²Department of Nursing, Inha University, Incheon, Korea

Corresponding author: Lee, Kang Im Surgical Intensive Care Unit, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon 400-711, Korea. Tel: +82-10-2426-7941, Fax: +82-32-890-3999, E-mail: white-blue98@daum.net

• Received: May 25, 2014 • Accepted: October 6, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
Cardiac arrest has multiple characteristics that need to be approached as an integrated method according to the various changes in the body system. This study was performed to develop a useful guideline for early detection of cardiac arrest by revealing the attributes of cardiac arrest through a concept analysis.
Methods
This study was conducted according to the Walker and Avant's concept analysis method. Systematic literature review and in-depth interview with nurses who experienced cardiac arrest situation were conducted. Based on the literature reviews and in-depth interviews with nurses, the attributes and the empirical referents of the concept of cardiac arrest were elicited.
Results
The definable attributes of cardiac arrest were 1) loss of consciousness, 2) abnormal respiratory condition, 3) abnormal cardiovascular signs. Cardiac arrest was found to occur by several antecedents such as cardiac problem, non-cardiac problem, or general problem, whereas ischemia and re-perfusion injury, which can lead to multiple organ failure and death, were derived as consequences.
Conclusion
In this study, the concept analysis eliciting attributes and empirical referents is found to be useful as a guideline for understanding and managing cardiac arrest. Based on these findings, clinical providers are expected to make a precise and rapid decision on cardiac arrest and respond quickly, which may increase survival rate of the patients underwent the arrest event.
Key Words: Cardiac arrest; Concept analysis

Figure 1.

Flow diagram of literature selection process.

Figure 2.

Attributes, antecedents and consequences of cardiac arrest.

Table 1.

Attributes and Contents of Cardiac Arrest in Literature Review

Attributes	Researches	Contents
Unresponsiveness/ unconsciousness	AHA (2010a, 2010c); Cho (2013); Christian, et.al (2011);	․ Tap the victim's shoulder & shout
	Jun (2006); Jung & Chung (2010); KACPR (2011);	"Are you all right?"
	Kobayashi, et al. (2010); Kwon (2012); Nolan (2011);	․ No movement or response
	On (2006); Ornato (2009); Sandroni, Nolan, Cavallaro,
	& Antonelli (2007); Yu, et al. (2007);
Apnea	AHA (2010a, 2010c); Cho (2013); Christian, et.al (2011);	․ Look, listen, and feel
	Jun (2006); Jung & Chung (2010); Kobayashi, et al	․ No more than 10 sec to determine
	(2010); Kwon (2012); Sandroni, Nolan, Cavallaro, &
	Antonelli (2007); Yu, et al. (2007);
Agonal respiration	Charles, et al. (2010); Cho (2013); Christian, et. al.	․ Abnormal breathing
	(2011); Korea Centers for Disease Control &	․ Snorting, gurgling or gasping sound
	Prevention (2011); Nolan (2011); Nolan, Soar, &	․ Irregular and sporadic
	Perkins (2012); Ornato (2009);	․ Laboured or noisy breathing
	Sandroni, Nolan, Cavallaro, & Antonelli (2007);
Absence of detectable pulse	AHA (2010a, 2010c); Jung & Chung (2010); Jun (2006);	․ Carotid pulse detect
	Kim, Jun, Kim,& Choi (2008); Kobayashi, et al. (2010);	․ Femoral pulse detect
	Kwon (2012); Ruzman, Tot, Ivic, Gulam, Rutman, &	․ No more than 10 sec to determine
	Burazin, (2013); Sandroni, Nolan, Cavallaro, &
	Antonelli (2007); Yu, et al. (2007)
Arrythmia	AHA (2010a, 2010c); Kim, Lee, Lee, & Kim (2012);	․ Ventricular fibrillation
	Korea Centers for Disease Control & Prevention	․ Pulseless ventricular tachycardia
	(2011); Yu, et al. (2007)	․ Asystole
		․ Pulseless electrical activity

Table 2.

Attributes of Cardiac Arrest in Field Work

Attributes	Narrative
Unresponsiveness/ unconsciousness	․ "Suddenly the patient was fell down, and shown no response to verbal stimulation" (Subject 1)
	․ "Patient showed no response to verbal stimulation, so I assessed pupil response and found that his pupil was dilated and fixed" (Subject 2)
	․ "The monitor alarm was ringing, and I found that the patient was in unconsciousness state" (Subject 3)
Apnea	․ "The patient did not breathe, her lips were blue, and saturation level could not be monitored......" (Subject 3)
Apnea	․ "Because most of ICU patients had ventilator, patients' apnea state might not be obvious for cardiac arrest" (Subject 7)
Absence of detectable pulse	․ "I could not feel the patient's femoral pulse, so I suspected that cardiac arrest was broken out" (Subject 4)
Absence of detectable pulse	․ "I think carotid pulse must be palpated to confirm cardiac arrest, but I usually detect pulse from femoral artery" (Subject 5)
Arrhythmia	․ "EKG monitor alarm was ringing, so I checked monitor and found V-FIB. I immediately started to perform CPR." (Subject 6)
	․ "EKG monitor alarm was ringing, and I found V-tac from the screen." (Subject 8)
	․ "If I observed flatness of EKG, I usually made announcement for CPR" (Subject 9)

REFERENCES

American Heart Association. 2010a. Guidelines CPR & ECC. Dallas, TX: American Heart Association.
American Heart Association. 2010b. BLS for healthcare provider student manual. Dallas, TX: American Heart Association.
American Heart Association. 2010c. Advanced cardiovascular life support provider manual. Dallas, TX: American Heart Association.
Chan P. S., Nallamothu B. K.. 2012;Improving outcomes following in hospital cardiac arrest. The Journal of the American Medical Association. 307:1917–-1918.
Charles D. D., Jerry P. N., Jasmeet S., Kjetil S., Rudolph W. K., Gary B., et al. 2010;European resuscitation council guidelines for resuscitation 2010. Resuscitation. 81:1305–-1352.
Cho H. S.. 2013;Relationship between cardiopulmonary resuscitation knowledge, professional attitude, and job performance: A descriptive analysis of medium-to small-sized hospital nurses Unpublished master's thesis. Ajou University, Suwon..
Christian V., Manya L. C., Katarina B., James D., Maaret C.. 2011;In out-of hospital cardiac arrest patients, does the description of any specific symptoms to the emergency medical dispatcher improve the accuracy of the diagnosis of cardiac arrest:. A systematic review of the literature. Resuscitation. 82:1483–-1489.
Hajbaghery M. A., Mousavi G., Akbari H.. 2005;Factors influencing survival after in-hospital cardiopulmonary resuscitation. Resuscitation. 66:317–-321.
Article
Ji J. G.. 2000. Medical terminology dictionary. Anyang: Academia.
Jun H. C.. 2006;Education effect of CPR and external defibrillator training program for nursing staff Unpublished master's thesis. Gachon University, Incheon..
Jung J. Y., Chung Y.. 2010;Development of a prehospital protocol on cardiopulmonary resuscitation of 119 emergency medical technicians. Korean Institute of Fire Science & Engineering. 24(2):185–-193.
Kim S. S., Kim B. J.. 2006;Outcome of in-hospital cardiopulmonary resuscitationaccording to the in-hospital ustein style in a general hospital. Clinical Nursing Research. 11:177–-192.
Kim E. J., Lee K. R., Lee M. H., Kim J. Y.. 2012;Nurse's cardiopulmonary resuscitation performance during the first 5 minutes in in-situ simulated cardiac arrest. Journal of Korean Academy Nursing. 42(3):361–-368.
Article
Kim J. Y., Jun S. S., Kim D. H., Choi S. S.. 2008;Knowledge and attitude toward BLS and provided CPR education among nurses at general wards in Pusan. The Korean Journal of Fundamentals of Nursing. 15(2):143–-152.
Kobayashi L., Lindquist D. G., Jenouri I. M., Dushay K. M., Haze D., Sutton E. M., et al. 2010;Comparison of sudden cardiac arrest resuscitation performance data obtained from in-hospital incident chart review and in situ high-fidelity medical simulation. Resuscitation. 81:463–-471. http://dx.doi.org/10.1016/j.resuscitation.2010.01.003.
Korean Association of Cardiopulmonary Resuscitation. (KACPR). 2011. Korea guideline for cardiopulmonary resuscitation. Seoul: Author.
Korea Centers for Disease Control & Prevention. 2011;Development of guidelines for citizens' action to sudden cardiac arrest Retrieved June 30, 2013 from.http://www.cdc.go.kr/CDC/info/CdcKrInfo0210.jsp?menuIds=HOME001-MNU1155-MNU1083-MNU1375-MNU0566&cid=22002.
Kwon Y. O.. 2012;Task analysis of ICU nurse about CPR Unpublished master's thesis. Seoul National University, Seoul..
Lee J. A., Park I. S.. 2003;The experiences of nurses in emergency situation..Chungnam Journal of Nursing Academy.
Marsch S. C., Tschan F., Semmer N., Spychiger M., Breuer M., Hunziker P. R.. 2005;Performance of first responders in simulated cardiac arrest. Critical Care Medicine. 33:963–-967.
Merchant R. M., Yang L., Berker L. B., Berg R. A., Nadkarni V., Nichol G., et al. 2011;Incidence of treated cardiac arrest in hospitalized patient in the United States. Critical Care Medicine. 39:2401–-2406.
Nolan J. P.. 2011;Optimizing outcome after cardiac arrest. Current Opinion in Critical Care. 17:520–-526.
Article
Nolan J. P., Soar J. S., Perkins G. D.. 2012;Cardiopulmonary resuscitation. British Medical Journal. 345:e6122http://dx.doi.org/10.1136/bmj.e6122.
On Y. G.. 2006. ECG for nurse. 2nd ed.. Seoul: Daehakseo-won.
Ornato J. P.. 2009;Science of emergency medical dispatch. Circulation. 119:2023–-2025.
Article
Park C. W., Ok T. G., Cho J. H., Cheon S. W., Lee S. Y., Kim S. E., et al. 2005;A study of the effectiveness of CPR training to the personnels of nursing department in the hospital. Journal of the Korean Society of Emergency Medicine. 16(4):474–-480.
Ruzman T., Tot O. K., Ivic D., Gulam D., Rutman N., Burazin J.. 2013;In-hospital cardiac arrest: Can we change something?.The Central European Journal of Medicine http://dx.doi.org/10.1007/s00508-013-0409-0.
Sandroni C., Nolan J., Cavallaro F., Antonelli M.. 2007;In-hospital cardiac arrest: Incidence, prognosis and possible measures to improve survival. Intensive Care Medicine. 33(2):237–-245. http://dx.doi.org/10.1007/s00134-006-0326-z.
Article
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Walker L. O., Avant K. C.. 2004. Strategies for theory construction in nursing. 4th ed.. Norwalk, CT: Princeton Hall.
Yu J. S., Choi H. K., Whang J. H., Kim B. J., Oh H. S., Kim J. W., et al. 2007;Development of a nursing protocol on CPR for non-traumatic adults in emergency setting. Clinical Nursing Research. 13(1):113–-125.

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Concept Analysis of Cardiac Arrest: Identifying the Critical Attributes and Empirical Indicators

Korean J Adult Nurs. 2014;26(5):573-583. Published online October 31, 2014

DOI: https://doi.org/10.7475/kjan.2014.26.5.573

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Concept Analysis of Cardiac Arrest: Identifying the Critical Attributes and Empirical Indicators

Korean J Adult Nurs. 2014;26(5):573-583. Published online October 31, 2014

DOI: https://doi.org/10.7475/kjan.2014.26.5.573

Figure

Concept Analysis of Cardiac Arrest: Identifying the Critical Attributes and Empirical Indicators

Figure 1. Flow diagram of literature selection process.

Figure 2. Attributes, antecedents and consequences of cardiac arrest.

Figure 1.

Figure 2.

Concept Analysis of Cardiac Arrest: Identifying the Critical Attributes and Empirical Indicators

Table 1.

Attributes and Contents of Cardiac Arrest in Literature Review

Attributes	Researches	Contents
Unresponsiveness/ unconsciousness	AHA (2010a, 2010c); Cho (2013); Christian, et.al (2011);	․ Tap the victim's shoulder & shout
	Jun (2006); Jung & Chung (2010); KACPR (2011);	"Are you all right?"
	Kobayashi, et al. (2010); Kwon (2012); Nolan (2011);	․ No movement or response
	On (2006); Ornato (2009); Sandroni, Nolan, Cavallaro,
	& Antonelli (2007); Yu, et al. (2007);
Apnea	AHA (2010a, 2010c); Cho (2013); Christian, et.al (2011);	․ Look, listen, and feel
	Jun (2006); Jung & Chung (2010); Kobayashi, et al	․ No more than 10 sec to determine
	(2010); Kwon (2012); Sandroni, Nolan, Cavallaro, &
	Antonelli (2007); Yu, et al. (2007);
Agonal respiration	Charles, et al. (2010); Cho (2013); Christian, et. al.	․ Abnormal breathing
	(2011); Korea Centers for Disease Control &	․ Snorting, gurgling or gasping sound
	Prevention (2011); Nolan (2011); Nolan, Soar, &	․ Irregular and sporadic
	Perkins (2012); Ornato (2009);	․ Laboured or noisy breathing
	Sandroni, Nolan, Cavallaro, & Antonelli (2007);
Absence of detectable pulse	AHA (2010a, 2010c); Jung & Chung (2010); Jun (2006);	․ Carotid pulse detect
	Kim, Jun, Kim,& Choi (2008); Kobayashi, et al. (2010);	․ Femoral pulse detect
	Kwon (2012); Ruzman, Tot, Ivic, Gulam, Rutman, &	․ No more than 10 sec to determine
	Burazin, (2013); Sandroni, Nolan, Cavallaro, &
	Antonelli (2007); Yu, et al. (2007)
Arrythmia	AHA (2010a, 2010c); Kim, Lee, Lee, & Kim (2012);	․ Ventricular fibrillation
	Korea Centers for Disease Control & Prevention	․ Pulseless ventricular tachycardia
	(2011); Yu, et al. (2007)	․ Asystole
		․ Pulseless electrical activity

Table 2.

Attributes of Cardiac Arrest in Field Work

Attributes	Narrative
Unresponsiveness/ unconsciousness	․ "Suddenly the patient was fell down, and shown no response to verbal stimulation" (Subject 1)
	․ "Patient showed no response to verbal stimulation, so I assessed pupil response and found that his pupil was dilated and fixed" (Subject 2)
	․ "The monitor alarm was ringing, and I found that the patient was in unconsciousness state" (Subject 3)
Apnea	․ "The patient did not breathe, her lips were blue, and saturation level could not be monitored......" (Subject 3)
Apnea	․ "Because most of ICU patients had ventilator, patients' apnea state might not be obvious for cardiac arrest" (Subject 7)
Absence of detectable pulse	․ "I could not feel the patient's femoral pulse, so I suspected that cardiac arrest was broken out" (Subject 4)
Absence of detectable pulse	․ "I think carotid pulse must be palpated to confirm cardiac arrest, but I usually detect pulse from femoral artery" (Subject 5)
Arrhythmia	․ "EKG monitor alarm was ringing, so I checked monitor and found V-FIB. I immediately started to perform CPR." (Subject 6)
	․ "EKG monitor alarm was ringing, and I found V-tac from the screen." (Subject 8)
	․ "If I observed flatness of EKG, I usually made announcement for CPR" (Subject 9)

Table 1. Attributes and Contents of Cardiac Arrest in Literature Review

Table 2. Attributes of Cardiac Arrest in Field Work

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