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)
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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
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.
Jay Khadpe MD
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