Decision making to cease or to continue cardiopulmonary resuscitation (CPR)

Abstract

CPR should be initiated in any patient who has a cardiac arrest. This might improve overall outcome but implies that CPR is started in patients without any virtual chance for long-term survival (LTS). The aim of this study is, by analysing retrospectively 2713 out-of-hospital cardiac arrests (CA), to identify indices which might be of help in the decision making to continue or to discontinue CPR. In an important number of unsuccessful CPR attempts ALS-time did not exceed 20 min. This occurred more frequently in subgroups where limited chances of LTS are expected on clinical grounds. The decision to cease CPR might have been based on other clinical and/or ethical parameters which were not recorded in the registry. This behavior results in a "self-fulfilling prophecy". A subset of patients with limited chances for LTS (0/405) can be identified: patients in electromechanical dissociation (EMD) or asystole on arrival of the mobile intensive care unit (MICU) team, without pupil reaction to light during CPR and with inefficient cardiac massage by the MICU (405/2713). Other patients in EMD or asystole without pupil reaction to light during CPR (1373/2713) but with efficient ECC should be resuscitated for more than 30 min, especially if the patient is gasping during CPR (LTS 27/1373). Patients in EMD or asystole on arrival of the MICU with pupil reaction to light during CPR (236/2713) should have an ALS-time of at least 45 min (LTS 42/236). Cardiac arrests in ventricular fibrillation (VF) (699/2713) should be resuscitated for at least 45 min, especially when gasping during CPR (LTS 119/699).