Critique of Research Article

The title of the study defines the rationale for the study, yet the statement lacks much information in characterizing the area where the survey was conducted. Before a reader can even look at the abstract, different components of the published work should be included, according to the recommendations for creating the title of a study (1473). First, they fail to specify the location of the study, which makes it appear too broad to be carried out. Also, from the provided title, it is not easy to differentiate between the dependent and independent variables and the readers had to read through the article to identify these aspects while the population under study is not indicated.

However, the study is made feasible by the fact that the authors are all high ranking within the field of health. It provides an overview of the different qualifications that the authors hold and the sections of healthcare that they have been involved in giving credit to the efficacy of the research (1474). They have authority within the subject related to the study and affiliations and credentials that are reliable for the approval of any research topic. They also obtained funding from the national institute of health and the American Heart Association that made it possible to conduct the studies in the extended period.

Consequently, the authors provide an abstract that demonstrates the different sections of the study. As such, it describes the background of the study, methods used, gives the results, interpretation and the conclusion derived from the survey (1473). Additionally, its states the agencies that provided the appropriate funding showing the possibility of carrying out the research. In this way, the readers can easily get to the aspects they require without having to read through the whole study and also understand the background that informed the research. The methods give an overview of the time frame and the sample size within the given guidelines of resuscitation registry and therefore easier to identify and therefore easily grabs the attention of the readers. Though it has exceeded the maximum word count by about 40 words, it is concise and can easily be understood by all and also used as a reference without going through the whole paper.

The research paper does not correctly identify a section for the statement of the problem, and the reader has to go through the entire introduction to determine what the authors based their research. As such, through the introduction, we identify that the basis of their study of the few studies that have been carried out to guide clinicians on the designated length of time resuscitating a patient before terminating the efforts (1474). The clinicians were seen to be reluctant in continuing resuscitation efforts in the case when the return of circulation is not spontaneous. Though the statement is not sufficiently narrow in scope, the problem is significant in ensuring that patients are not left to suffocate to death without enough effort from the clinicians to resuscitate them. Also, the purpose is defined in that there are variations in the routine practice on the attempts of resuscitation of non-survivors with relation to the rate of survival. Therefore, with the purpose defined and the sample size identified through a specified period, the project is significant, feasible and researchable.

The study used recent literature to back up their study though some were old such as that from 1983 since they were viable enough to be included in the survey. Some of the old secondary sources were used because only a few studies had been carried out on the length of resuscitation (1474). As such, though all the references are not current, they are pertinent and representative of the specific variables that needed to be captured in the research. Also, since the study was carried out between 2000 and 2008, it was still feasible to use the sources that were within the range of ten years. Additionally, the paper does not provide a theoretical framework which could have been important in giving a better understanding of the whole study in relation to other similar articles. It could have been imperative to relate all the variables that affect the study leading to the relevant findings that were obtained. In this way, the study would have described the dependent, independent and confounding variables and their effect on the study. As such, the duration of resuscitation, survival of the patients after in-hospital cardiac arrest and other factors like the support from clinicians, together with the assumptions made would have been related effectively in the theoretical framework.

Evaluation of research methods

The authors used an observational study that examined the relationship between the resuscitation period and the patient's outcome. They tested that hypothesis that hospitals with longer duration of attempted resuscitation in patients who did not survive had a higher correction with the survival outcome of the hospital (1475). Also, they did an assessment of the association between poor neurological status and higher survival rates while directly estimating the ratio of different groups at risk of cardiac arrest. Their hypothesis was therefore clearly implied with the research variables being the duration of resuscitation. Hospital survival rates, poor neurological status and the risk of cardiac arrest in patients who survived.

Data collection was carried out within the 537 acute care hospitals included in the study both from USA and Canada (1475). Data was collected by a method of observation from the multicentre observational registry for resuscitation. Also, other research personnel was trained to get data from the in-hospital patients with cardiac arrest through specific observable characteristics. The logs of hospital electronic pages were also reviewed, and routine checks of emergency resuscitation equipment carried out to inform different variables from the study (1475). Conversely, the study did not provide reliability and validity of the used instruments since much of the research was based on observation. Other designs would have been considered to give better results since the study used observations does not allow the researchers to take into consideration the causal relationship demonstrated with possible errors in data collection. The study does not on also indicate the process they used in obtaining the patients' consent though by working with specific hospitals they should already have obtained the relevant documents for permissions. On the other hand, they took into consideration the privacy of the information gathered from different patients by ensuring that it was presented as ethically as possible.

Data Analysis

The study targeted the in-hospital patients that were admitted to various hospitals in USA and Canada who had suffered a cardiac arrest and had been involved in resuscitation within out of the emergency room. The accessible population consisted of 64339 patients within 435 acute hospitals in both USA and Canada that were adults and an index in-hospital cardiac arrest (1476). The sample size included in the study was sufficient to make a final observation regarding the subject matter and come up with conclusive findings. A statistical analysis of the patients was adequately carried out through descriptive such as the difference in baseline demographics and their clinical characteristics across all the patients tested for resuscitation duration. Also, the patients were also stratified according to their survival status while the X2 tests and Kruskal-Wallis were used for the description of the sample (1477).

Additionally, multiple regression models were used with random intercepts that were hospital-specific to establish the association between the average duration of resuscitation and the return of circulation in patients. Also, the models were used in estimating the identified risk ratios for the different patients. According to the analyzed results, there was a bias in the gender of patients involved in the study since only a full description of the male population is provided though homogeneity was established through the mean age and the exclusion criteria employed for the research.

The results were presented at a confidence interval of 95% with a p value of 0.858 after an adjustment of the risk ratio (1477). It was indicated that the patients with the longest medium resuscitation were better placed to survive and get discharged as compared t those involved in shorter periods. They were significant results for patients with cardiac arrest since they experienced a pulseless electrical activity. Statistical significance indicates that the results of the study are measurable and the relationship obtained is feasible to be used in deriving the appropriate conclusions for the study.

Discussion and Conclusion

The nature of research in using observations limits its ability to adequately present a causal relationship for the patients since follow up is not done after discharge. There were, therefore, several limitations related to the study of several factors that prevent generalizing to all hospitals across the different countries (1478). The hospital used a selected few of the larger hospital in Canada and the United States. Comparing to the previous work, they found a higher rate of error in the same registry that had been used. Some of the relevant departments where resuscitation is carried out were such as emergency and operation were excluded from the study. Using the data to be true across all facilities would thus not be feasible with the survival ad functional rates of patients not easily recognized. More so, the study was not controlled for confounding variables which would have affected the results provided such as some of the hospital may have had better facilities than others leading to the significant differences observed.

The results of the study are, however, logically related to the stated hypotheses though they cannot be generalized to the target population due to a large number of confounding variables that were related to the study such as the specific hospitals included in the survey (1478). Clinicians would consider more research carried out in this area with an inclusion of all hospital levels to ensure that the results could easily be used for the target population. The study may have had statistical but lacked a clinical significance since it cannot be used to inform future activities during resuscitation. Extensive work in this area would be appropriate in building a better understanding of both chronic and acute aspects of patients with cardiac arrest management. There is confidence on the validity of the results with a consideration of the research team involved in the study. Their qualifications are efficient in informing the kind of research carried out and with few adjustments on the method employed the results could easily be used to inform practice. Also. The fact that a large sample size was used give credit to the study with the large amount of data collected with a professionally managed heart registry. As such, the provided design was essential in comparing practice within the different hospitals and control for the baseline characteristics.

Reference

Goldberger, Z. D., Chan, P. S., Berg, R. A., Kronick, S. L., Cooke, C. R., Lu, M., ... & American Heart Association Get With The Guidelines-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators. (2012). Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study. The Lancet, 380(9852), 1473-1481.