Morning Report: 11/15/2013

Thanks to Dr. LoCascio for today’s Morning Report!

 

Out-of-Hospital Cardiac Arrest

 

AMA Council on Ethical and Judicial Affairs states that CPR may be withheld, even if requested, “when efforts to resuscitate a patient are judged by the treating physician to be futile.”

ACEP “physicians are under no ethical obligation to render treatments that they judge have no realistic likelihood of medical benefit to the patient.”

Outcome of resuscitation for cardiac arrests depends on multiple factors

Overall survival of out of hospital cardiac arrest to hospital discharge 9.5% 2013 (American Heart Association)

Factors Predictive of Improved Outcomes after Cardiac Arrest

 

Witnessed arrest
Brief down time and early ACLS
Ventricular arrhythmias
Bystander CPR
Return of spontaneous circulation in response to ACLS protocols

 

 

Factors that are associated with a poor outcome following out-of-hospital sudden cardiac arrest:

  • Absence of any vital signs
  • Sepsis
  • CVA with severe neurologic deficit
  • Cancer or Alzheimer disease
  • History of more than two chronic diseases
  • A history of cardiac disease
  • Prolonged CPR more than five minutes

 

Japanese study of almost 400,000 patients with non-traumatic OHCA from 2005-2009, prospective database.  Neurologic outcome was defined in terms of Cerebral Performance Category ( 1 good, 4 vegetative state, 5 death)

  • Primary end point survival with favorable neurologic outcome at 1 month
  • Secondary endpoint was survival at 1 month

 

mr11152013p1

Goto Y, Meda T, Goto Y.  Decision-tree model for predicting outcomes after out-of-hospital cardiac arrest in the emergency department.  Crit Care.  2013; 17(4):R133.

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

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