EXPECTED DEATH AND UNWANTED RESUSCITATION IN THE PREHOSPITAL SETTING

Study objective: To determine the outcome, location, preexisting condi tions, and resuscitation wishes of prehospital cardiac arrest patients . Design: Retrospective review of paramedic and emergency medical tech nician run reports. Setting: Urban area with a two-tiered emergency me dical services response system covering an area of 2,128 square miles and serving a population of 1,413,900 (in 1988). Participants: All pre hospital cardiac arrest patients to which the King County, Washington, Emergency Medical Services (KCEMS) system responded to during a 12-mo nth period. Unless decapitation, decomposition, or dependent lividity existed, all cardiac arrest patients in the KCEMS system received full resuscitative efforts. Measurements: We analyzed run reports from 694 cardiac arrest patients, excluding all cardiac arrests from trauma, o verdose, or drowning, or obvious signs of extended downtime such as de composition or dependent lividity. We defined an unwanted resuscitatio n as a resuscitation attempt despite written or verbal requests by the patient, family, or private physician. We defined a patient as having severe, chronic disease if the run report listed one or more conditio ns associated with poor survival rates after inpatient CPR. These incl uded cancer, cerebral vascular accident, dementia, renal failure, dial ysis, AIDS, thoracic or abdominal aneurysms, cirrhosis, or if the pati ent was bedridden or was receiving chronic home nursing care. Main res ults: Overall 16% (103 of 633) of all cardiac arrest patients survived to hospital discharge. Seven percent (47 of 633) of all cardiac arres t patients fit the unwanted resuscitation definition; 2% (one of 47) s urvived to hospital discharge. Twenty-five percent (158 of 633) of car diac arrest patients fit the definition of severe chronic disease; 8% (12 of 158) survived to hospital discharge. Conclusion: Severe chronic disease and unwanted resuscitation patients comprised one-third of al l resuscitation attempts by KCEMS during a 12-month period. Both group s had lower survival rates compared to cardiac arrest patients who did not have severe chronic disease or indications of unwanted resuscitat ion.