When to stop resuscitation in cardiac arrest cases

According to a newly published report as many as two-thirds of cardiac arrest patients who are taken to hospitals by emergency medical technicians (EMT's) die despite efforts to revive them.

Most could be declared dead at the scene, and according to the researchers certain emergency medical services, other than those staffed by paramedics, could ease the distress of loved ones and dramatically reduce the number of hopeless but expensive hospital trips.

The researchers found that of 1,240 cardiac arrest rescue runs over two years in Ontario, Canada, only 1 in 500 people survived to be discharged from the hospital if EMTs could not resuscitate them.

The team led by Dr. Laurie Morrison, associate professor of emergency medicine at the University of Toronto, say new guidelines stating when EMTs should halt resuscitation attempts are needed and would result in a decrease in the rate of transportation from 100 percent of patients to 37.4 percent.

The researchers say expecting medical personnel to keep treating cardiac arrest patients in futile situations limits the availability of emergency personnel to care for other patients, increases patients' waiting times in emergency departments, decreases the available beds and equipment in emergency departments and hospitals, and diverts care from patients who are potentially more likely to survive.

Morrison says new guidelines would possibly make it easier for loved ones to cope as having a sudden death pronounced at the scene seems to be more therapeutic than having it done at a hospital.

She believes when family members observe a resuscitation attempt that is unsuccessful, they feel that everything that could be done was done, whereas a 20 or 30 minute wait in an emergency department, is tough on families.

The researchers advise that the findings do not apply to victims of cardiac arrest treated by EMTs who are trained in advanced life support techniques, or to paramedics, who are trained to use various medicines and intubation to try to restart the heart and keep patients alive.

Paramedics already have similar standards.

The guidelines which are published in the Aug. 3 issue of the New England Journal of Medicine, are not professing to offer the final word, and depend on a number of factors, including cost and geographic region.

According to the American Heart Association, cardiac arrest is the sudden, abrupt loss of heart function and the study has identified three factors in patients who did not survive out-of-hospital cardiac arrest: no return of spontaneous circulation before transportation began; no shock given before transportation; the cardiac arrest was not witnessed by EMS personnel.

The guidelines recommend the termination of resuscitation if these three factors are in place.

Guidelines are already exist for advanced-level paramedics, but not for emergency-medical technicians (EMTs) trained in the use of automated external cardiac defibrillators, which shock a heart back into a normal rhythm.

As a result, many patients who have little or no chance for survival are nevertheless taken to emergency departments.

Morrison says if the situation is futile, resources can be directed towards the family.

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