THE DECISION TO TERMINATE RESUSCITATIVE EFFORTS - RESULTS OF A QUESTIONNAIRE

Despite all the progress made in emergency medicine, out-of-hospital r esuscitative efforts still remain unsuccessful in the majority of case s and a decision concerning termination of cardiopulmonary resuscitati on (CPR) has to be made. We used a multi-question survey to assess the attitude of emergency physicians towards the duration of an unsuccess ful resuscitation attempt in non-traumatic cardiac arrest, and to iden tify the criteria affecting the decision to terminate CPR in the preho spital setting. More than 400 physicians participated in the inquiry o n CPR in adults. If spontaneous circulation cannot be restored, the ma jority (65%) abandon the resuscitation attempt at the latest after per forming advanced cardiac life support for 45 min. The participants ind icated the following factors as criteria for the termination of unsucc essful CPR: pre-existing diseases (92%), presumed interval between ons et of arrest and application of CPR (92%), duration of the resuscitati on attempt (90%), age of the patient (89%), electrocardiographic (EGG) alterations such as persistent asystole/ventricular fibrillation or e lectromechanical dissociation (83%), persistent fixed and dilated pupi ls (78%), lack of brain stem reflexes (31%), body temperature (12%) an d suspected drug intoxication (8%). The answers reflect the physicians ' opinions on termination of CPR even if they do not present real deci sions under emergency conditions. The results indicate that in additio n to the failure to restore spontaneous circulation, other factors are involved in decision making at the scene. A high rate of respondents include criteria of weak diagnostic value such as the pupillary status , or factors of doubtful prognostic significance such as the patient's age. Concerning the patient's history and underlying diseases, the em ergency physician often has to resort to presumptions. We conclude tha t the decision to terminate CPR is made by most physicians considering the specific circumstances of the cardiac arrest. (C) 1997 Elsevier S cience Ireland Ltd.