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Decisions to terminate resuscitation. Resuscitation Committee
R de Vos1, L Oosterom, R W Koster
1Academic Medical Center, University of Amsterdam, The Netherlands. r.vos@amc.uva.nl
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.
Abstract:
To gain more insight into decision making around the termination of resuscitation (CPR), we studied factors which influenced the time before discontinuing resuscitation, and the criteria on which those decisions were based. These criteria were compared with those of the European Resuscitation Council (ERC) and the American Heart Association (AHA). For this study, we reviewed the audiotapes of resuscitation attempts in a hospital. A total of 36 attempts were studied, involving 27 men and nine women, mean (S.D.) age 64 (18) years. A total of 19 patients received resuscitation on general wards, and 17 in the emergency room after an out-of-hospital circulatory arrest. The median interval time (range) from start to termination was 33 min (8-81 min). Results from multiple linear regression showed that a delay greater than 5 min in first advanced life support measures, drawing a sample for biochemical analysis, and the patient's response shown by return of spontaneous circulation were independently associated with the time of terminating resuscitation. The team used a number of criteria which can be found in the guidelines of the ERC and the AHA, but also used additional criteria. The ERC and the AHA criteria were not sufficient to cover all termination decisions. We conclude that the point in time to terminate resuscitation is not always rationally chosen. Updating of the current guidelines for terminating resuscitation and training resuscitation teams to use these guidelines is recommended.