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

Kang Im Lee; Hyun Soo Oh

doi:10.7469/kjan.2014.26.5.573

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

Original Article

Korean J Adult Nurs 2014;26(5):573-583.

Published online: NaN October 2014

DOI: https://doi.org/10.7469/kjan.2014.26.5.573

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

Kang Im Lee^1,, Hyun Soo Oh²

^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 25 May 20142 October 2014 Accepted 6 October 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.

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.

Keywords: Cardiac arrest, Concept analysis

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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)

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