Ethical aspects of prehospital CPR

Obvious reasons to withhold CPR are signs of death or fatal trauma. If there is any doubt about the appropriateness of CPR, resuscitative measures should be performed. However, CPR should not be attempted like a reflex action, without considering the individual circumstances, the patient's preferences and his prognosis. Age or preexisting diseases are factors that might affect the withholding or withdrawing of CPR, although the decision should not be based solely on these factors, but on criteria with a better predictive value, such as the initial cardiac rhythm and the course of CPR application. Changes in cardiac rhythm might be of prognostic value, because rhythms other than ventricular tachycardia or fibrillation tend to predominate the longer an arrest is in progress. The outcome worsens with prolonged CPR. A termination of unsuccessful CPR after 30 to 45 minutes seems to be reasonable. With respect to the preservation of life as one of the main goals of medicine we have to accept the ethical dilemma that CPR is performed in a number of patients although retrospectively it turns out to have been inappropriate or unwanted by the patient. Nevertheless, therapeutic interventions might be stopped later on after additional information has been obtained. Ethical principles should be taken into account as an action guide when considering the decision to withhold or to terminate resuscitative efforts. However, a detailed and individual ethical analysis in case of conflict is difficult and often impossible in the prehospital emergency situation.