Abstract 16023: Physicians Feel Competent in Deciding When to Terminate Resuscitation but Have Limited Knowledge on Termination Guidelines and Rely on Unvalidated and Controversial Factors When Abandoning Resuscitation

Abstract

Introduction: Many resuscitation attempts do not succeed and have to be terminated. Several factors may influence the decision to terminate cardiopulmonary resuscitation (CPR) e.g. medical history, cause of cardiac arrest and anticipated prognosis. The aim of this study was to investigate self-assessed competence in terminating CPR and knowledge of the European Resuscitation Council (ERC) guidelines on termination of resuscitation. In addition, to evaluate single factors resulting in abandonment of CPR. Methods: Questionnaires were distributed to participants before advanced life support training at a university hospital. Participants included nurses and physicians serving as cardiac arrest team leaders and members from emergency, cardiology and intensive care departments. The questionnaire included questions on: 1) self-assessed competence in terminating CPR, 2) knowledge of ERC guidelines on termination of resuscitation, and 3) single factors resulting in abandonment of CPR. Data were collected from October 2014 through May 2015. Results: In total, 215 answers (response rate: 97%; 136 nurses and 79 physicians) were included in the study. Overall, 67% of physicians felt competent in deciding when to terminate CPR. No nurses and two (3%) physicians were able to state the ERC guidelines on when to terminate CPR. Physicians stated the following factors as single causes to terminate CPR: asystole for >20 min and no uncorrected reversible cause of cardiac arrest (75%), witnessed cardiac arrest without bystander CPR within 10 minutes (20%), cardiac standstill during echocardiography (19%), absence of pupillary light reflex during resuscitation (17%), age above 90 years (18%), known cancer (13%) and prolonged cardiac arrest with shockable rhythm (9%). Conclusions: Physicians feel competent in deciding when to terminate CPR. Knowledge on ERC guidelines for termination of resuscitation is limited. Physicians rely on unvalidated and controversial factors as sole ground for abandoning CPR.