Avoiding the futility of resuscitation

To identify patients who should not have resuscitation started or continued.

Multi-disciplinary prospective study.

Two hundred forty-one consecutive patients with cardiopulmonary arrests from January 1995 to February 1997 were evaluated, of which 200 were studied.

Subjects were studied for age, sex, arrest location, CPR duration, recovery from arrest, hospital discharge, 6 weeks' survival, sepsis and co-morbid conditions.

Overall 69 (34.5%) recovered from the arrest, 24 (12.0%) left the hospital, and 17 (8.5%) survived 6 weeks. Of inpatients, 13.7% (16/117) were alive at 6 weeks in contrast to 1.2% (1/83) of field/emergency room (ER) arrests. Sepsis did not lessen the immediate recovery rate; however, none of 25 septic patients survived hospitalization. Outcomes were not different between men and women or regular floor and ICU/CCU arrests. Age of survivors was the same as non-survivors. Survivors were resuscitated for 18.7+/-16.5 min and non-survivors 33.1+/-18.4 min (P=0.15). The initial rhythm of asystole or the presence of three or more co-morbid conditions had a negative prognosis.

CPR survival is problematic, and it is especially poor in field/BR arrests. Emergency squads should terminate CPR for pulseless patients after communicating with the ER physician. Age is not a determinant of recovery or survival. Arrest outside of the hospital, sepsis, three or more co-morbid conditions, previous CPR, asystole or resuscitation for >25 min all decrease the chance of hospital discharge and survival. Instituting or continuing CPR in a great majority of these patients is futile. Families should be so advised.