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Ethical Concerns in Healthcare:
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Quantifying physician's bias to terminate resuscitation. The TERMINATOR study.

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Summary

Physician bias significantly influences decisions to terminate resuscitation in cardiac arrest cases. Developing evidence-based guidelines is crucial to standardize this critical medical decision.

Keywords:
Cardiac arrestOutcomePrehospitalTermination of resuscitation

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Area of Science:

  • Emergency Medicine
  • Clinical Decision-Making
  • Cardiac Arrest Management

Background:

  • Termination of resuscitation (TOR) decisions in cardiac arrest are complex and often discretionary.
  • Lack of evidence-based criteria complicates the arbitration process for physicians.
  • Existing guidelines for TOR are scarce, leading to variability in practice.

Purpose of the Study:

  • To quantitatively evaluate the existence of physician bias in termination of resuscitation decisions.
  • To assess the impact of individual physician factors on TOR outcomes.
  • To identify potential areas for guideline development in cardiac arrest management.

Main Methods:

  • Analysis of 5,144 out-of-hospital cardiac arrests (OHCAs) from the RéAC registry (January 2013 - September 2021).
  • Utilized generalized linear mixed models to analyze the binary TOR decision.
  • Incorporated Utstein data as fixed effects and physician-specific random effects to model personal bias.

Main Results:

  • A significant physician effect (p < 0.001) on TOR decisions was identified in 173 physicians.
  • The odds ratio for physician bias was 2.48, exceeding the impact of no-flow duration (10-20 minutes).
  • Physician bias impact was lower than factors like patient age (>85) or dependency for daily activities.

Conclusions:

  • Individual physician biases demonstrably influence termination of resuscitation decisions.
  • This bias has a greater impact than certain clinical factors, such as moderate no-flow duration.
  • Development of standardized tools and evidence-based guidelines is recommended to aid physicians in TOR decision-making.