Decision making in resuscitation from out of hospital cardiac arrest

To determine which factors are perceived by senior house officers (SHOs), consultants, and medical registrars in accident and emergency (A&E) medicine as being important in decision making.

132 SHOs in A&E medicine, of 172 attending an induction course at the start of their job (77%), completed a questionnaire relating to 20 factors of possible importance in decision making; 73 completed the questionnaire at six weeks and 55 at six months. Ten medical registrars and 31 consultants in A&E medicine also completed the questionnaire.

The SHOs were able to recognise bystander cardiopulmonary resuscitation and early advanced I support, as well as the presence of ventricular fibrillation, as important prognostic factors. There was considerable variation in all three groups in their opinions on the importance of the other factors considered. There was no obvious change in SHO responses over the period of training.

Lack of guidelines may result in more patients receiving resuscitation than are salvageable, as doctors maintain a low threshold for continuing resuscitation to avoid missing potential survivors. A decision making algorithm is recommended.