Decisions to terminate resuscitation

To gain more insight into decision making around the termination of resusci tation (CPR), we studied factors which influenced the time before discontin uing resuscitation, and the criteria on which those decisions were based. T hese criteria were compared with those of the European Resuscitation Counci l (ERC) and the American Heart Association (AHA). For this study, we review ed the audiotapes of resuscitation attempts in a hospital. A total of 36 at tempts were studied, involving 27 men and nine women, mean (S.D.) age 63 (1 8) years. A total of 19 patients received resuscitation on general wards, a nd 17 in the emergency room after an out-of-hospital circulatory arrest. Th e median interval time (range) from start to termination was 33 min (8-81 m in). Results from multiple linear regression showed that a delay greater th an 5 min in first advanced life support measures, drawing a sample for bioc hemical analysis, and the patient's response shown by return of spontaneous circulation were independently associated with the time of terminating res uscitation. The team used a number of criteria which can be found in the gu idelines of the ERC and the AHA, but also used additional criteria. The ERC and the AHA criteria were not sufficient to cover all termination decision s. We conclude that the point in time to terminate resuscitation is not alw ays rationally chosen. Updating of the current guidelines for terminating r esuscitation and training resuscitation teams to use these guidelines is re commended. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.