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Cessation of unsuccessful pediatric resuscitation--how long is too long?
A S O'Marcaigh1, W J Koenig, J A Rosekrans
1Department of Pediatric and Adolescent Medicine, Baylor College of Medicine, Houston, TX.
Insights
No consensus exists on how long to perform cardiopulmonary resuscitation (CPR) for pediatric patients. Factors like prognosis, PALS certification, and pediatric specialty influence decisions on stopping resuscitation efforts.
Area of Science:
- Pediatric Emergency Medicine
- Medical Education
- Clinical Decision-Making
Background:
- Pediatric resuscitation teams comprise diverse specialists, lacking standardized guidelines for terminating unsuccessful efforts.
- Establishing consensus on resuscitation duration is crucial for consistent pediatric emergency care.
Observation:
- A study surveyed 140 healthcare professionals on optimal duration for unsuccessful pediatric resuscitation.
- Participants considered hypothetical cases with good and poor prognoses.
Findings:
- No clear consensus emerged on resuscitation duration.
- Shorter durations were favored for poorer prognoses (P < 0.01).
- Pediatric Advanced Life Support (PALS) certification and pediatric specialty were associated with briefer resuscitation times (P < 0.01).
Implications:
- Lack of consensus highlights a need for standardized guidelines in pediatric resuscitation.
- PALS certification and specialization in pediatrics may improve decision-making consistency.
- Further research could explore uniform approaches involving pediatric specialists or PALS-certified physicians.
Abstract:
Emergency teams asked to provide cardiopulmonary resuscitation for pediatric patients often consist of nurses and physicians from various pediatric and nonpediatric specialties. Team members should agree on the timing of termination of unsuccessful resuscitative efforts; however, no firm guidelines about such timing have been established. The purposes of this study were to determine (1) whether a consensus exists among health-care professionals about the optimal duration of unsuccessful resuscitation for pediatric patients and (2) whether attitudes are influenced by individual case prognosis, medical specialty, level of training, or certification in pediatric advanced life support (PALS). By random selection, 140 physicians, nurses, and medical students were asked to specify the duration that they would continue unsuccessful resuscitative efforts for each of two hypothetical cases: one patient with a good prognosis for survival and one with a poor prognosis. Although no clear consensus existed, all groups of health-care providers chose significantly briefer durations of resuscitation for the case with a poorer prognosis (P < 0.01). The specified durations of resuscitation were briefer for those who had PALS certification than for those who did not and for pediatricians than for nonpediatric physicians (P < 0.01). Furthermore, PALS certification (P < 0.01) and pediatric specialty (P < 0.05) contributed as independent variables in influencing the study participants' attitudes about duration of resuscitation, whereas level of training did not. We conclude that no consensus exists among the groups studied on the optimal duration of unsuccessful resuscitative efforts in pediatric patients. We speculate that the opinions might be more uniform if resuscitation of pediatric patients was provided primarily by pediatricians or PALS-certified physicians.