DECISION-MAKING IN RESUSCITATION FROM OUT-OF-HOSPITAL CARDIAC-ARREST

Objective-To determine which factors are perceived by senior house off icers (SHOs), consultants, and medical registrars in accident and emer gency (A&E) medicine as being important in decision making. Methods-13 2 SHOs in A&E medicine, of 172 attending an induction course at the st art of their job (77%), completed a questionnaire relating to 20 facto rs of possible importance in decision making; 73 completed the questio nnaire at six weeks and 55 at six months. Ten medical registrars and 3 1 consultants in A&E medicine also completed the questionnaire. Result s-The SHOs were able to recognise bystander cardiopulmonary resuscitat ion and early advanced I support, as well as the presence of ventricul ar fibrillation, as important prognostic factors. There was considerab le variation in all three groups in their opinions on the importance o f the other factors considered. There was no obvious change in SHO res ponses over the period of training. Conclusions-Lack of guidelines may result in more patients receiving resuscitation than are salvageable, as doctors maintain a low threshold for continuing resuscitation to a void missing potential survivors. A decision making algorithm is recom mended.