Cessation of Unsuccessful Pediatric Resuscitation—How Long Is Too Long?

Abstract

Emergency teams asked to provide cardiopulmonary resuscitation for pediatric patients often consist of nurses and physicians from various pediatric and nonpediatric specialties. Team members should agree on the timing of termination of unsuccessful resuscitative efforts; however, no firm guidelines about such timing have been established. The purposes of this study were to determine (1) whether a consensus exists among health-care professionals about the optimal duration of unsuccessful resuscitation for pediatric patients and (2) whether attitudes are influenced by individual case prognosis, medical specialty, level of training, or certification in pediatric advanced life support (PALS). By random selection, 140 physicians, nurses, and medical students were asked to specify the duration that they would continue unsuccessful resuscitative efforts for each of two hypothetical cases: one patient with a good prognosis for survival and one with a poor prognosis. Although no clear consensus existed, all groups of health-care providers chose significantly briefer durations of resuscitation for the case with a poorer prognosis (P < 0.01). The specified durations of resuscitation were briefer for those who had PALS certification than for those who did not and for pediatricians than for nonpediatric physicians (P < 0.01). Furthermore, PALS certification (P < 0.01) and pediatric specialty (P < 0.05) contributed as independent variables in influencing the study participants' attitudes about duration of resuscitation, whereas level of training did not. We conclude that no consensus exists among the groups studied on the optimal duration of unsuccessful resuscitative efforts in pediatric patients. We speculate that the opinions might be more uniform if resuscitation of pediatric patients was provided primarily by pediatricians or PALS-certified physicians.