Decisions to terminate resuscitation. Resuscitation Committee

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Published on: January 30, 2020

R de Vos1, L Oosterom, R W Koster

  • 1Academic Medical Center, University of Amsterdam, The Netherlands. r.vos@amc.uva.nl

Resuscitation
|January 26, 1999
PubMed

Insights

Decisions to stop cardiopulmonary resuscitation (CPR) are influenced by factors beyond established European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines. These guidelines may not fully encompass all criteria used in clinical practice.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Clinical Decision-Making

Background:

  • Cardiopulmonary resuscitation (CPR) termination decisions are critical in emergency care.
  • Existing guidelines from the European Resuscitation Council (ERC) and American Heart Association (AHA) provide criteria for discontinuing resuscitation.
  • Understanding the real-world factors influencing these decisions is essential for improving patient outcomes.

Purpose of the Study:

  • To investigate factors influencing the timing and criteria for terminating CPR.
  • To compare clinical decision-making criteria with existing ERC and American Heart Association (AHA) guidelines.
  • To identify potential gaps in current guidelines for CPR termination.

Main Methods:

  • Review of audiotapes from 36 hospital resuscitation attempts.
  • Analysis of factors associated with the time to CPR termination using multiple linear regression.
  • Comparison of clinical termination criteria with ERC and AHA guidelines.

Main Results:

  • The median time from CPR initiation to termination was 33 minutes.
  • Delays in advanced life support, biochemical sampling, and return of spontaneous circulation were independently associated with termination time.
  • Clinical teams utilized criteria beyond those specified by ERC and AHA guidelines.

Conclusions:

  • Current European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines may be insufficient for all CPR termination decisions.
  • The timing of CPR termination is not always based on purely rational or guideline-driven factors.
  • Updating CPR termination guidelines and enhancing resuscitation team training are recommended.

Keywords:
Death and EuthanasiaEmpirical Approach

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