Resuscitation Decisions

  • P. E. Pepe
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 1996)

Abstract

Emergency Medical Services (EMS) practitioners often initiate and conduct certain resuscitations with much reluctance. Their emotions tell them that resuscitation of an asystolic, jaundiced 80 year old man reported to have metastatic pancreatic cancer is a fruitless endeavor. It can even be rationalized that allowing that person to die from a sudden cardiac arrest is more humane than attempting to prolong a life that may only be a painful, bedridden existence. On the other hand, there are arguments that any attempts to discriminate between those who should and should not be aggressively resuscitated is the first step on the road to genocide. How old is “too old?” Where does one draw the line? Who will decide such criteria for waiving resuscitation? In this line of thinking, failure to attempt resuscitation not only defies the Hippocratic oath, it neglects the patient’s ultimate right - the right to live.

Keywords

Expense Arena Pepe 

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References

  1. 1.
    Pepe PE, Levine RL, Fromm RE, Curka PA, Clark PS (1993) Cardiac arrest presenting with rhythms other than ventricular fibrillation: Contribution of resuscitation efforts toward total survivorship. Crit Care Med 21: 1838–1843PubMedCrossRefGoogle Scholar
  2. 2.
    Weaver WD, Cobb LA, Dennis D, Ray R, Hallstrom AP, Copass MK (1985) Amplitude of the ventricular fibrillation waveform and outcome after cardiac arrest. Ann Intern Med 102: 53–55PubMedGoogle Scholar
  3. 3.
    Cummins RO, Ornato JP, Thies WH, Pepe PE (1991) State-of-the-Art Review — Improving survival from sudden cardiac arrest: The “Chain of Survival” concept. A statement for Health Professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 83: 1832–1847PubMedGoogle Scholar
  4. 4.
    Weaver WD, Cobb LA, Hallstrom AP, Copass MK, Ray R, Emery M, Fahrenbruch C (1986) Considerations for improving survival from out-of-hospital cardiac arrest. Ann Emerg Med 15: 1181–1186PubMedCrossRefGoogle Scholar
  5. 5.
    Guidelines for cardiopulmonary resuscitation and emergency cardiac care (1992) Emergency Care Committee, Subcommittee on ACLS, American Heart Association. JAMA 268: 2171–2302CrossRefGoogle Scholar
  6. 6.
    McIntyre KM, Crimmins TJ, Safar P, Lo B, Weir RF, Pepe PE (1992) Ethical considerations in resuscitation. Part VIII. Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA 268: 2282–2288CrossRefGoogle Scholar
  7. 7.
    Pepe PE, Cobb LA, Persse DE, et al (1994) Improved criteria for waiving resuscitation efforts for out-of-hospital primary cardiac arrest. Ann Emerg Med 23: 619 (Abst)CrossRefGoogle Scholar
  8. 8.
    Marsden AK, Ng GA, Dalziel K, Cobbe SM (1995) When is it futile for ambulance personnel to initiate cardiopulmonary resuscitation? Br Med J 311: 49–51CrossRefGoogle Scholar
  9. 9.
    Bonnin MJ, Pepe PE, Clark PS (1993) Survival in the elderly following out-of-hospital cardiac arrest. Crit Care Med 21: 1645–1651PubMedCrossRefGoogle Scholar
  10. 10.
    Longstreth WT, Cobb LA, Fahrenbruch CE, Copass MK (1990) Does age affect outcomes of out-of-hospital cardiopulmonary resuscitation? JAMA 264: 2109–2110PubMedCrossRefGoogle Scholar
  11. 11.
    Tresch DD, Thakur RK, Hoffmann RG, Olson D, Brooks HL (1989) Should the elderly be resuscitated following out-of-hospital cardiac arrest? Am J Med 86: 145–150PubMedCrossRefGoogle Scholar
  12. 12.
    Kellerman AL (1993) Criteria for dead-on-arrivals, prehospital termination of CPR and do-not-resuscitate orders. Ann Emerg Med 22: 47–51CrossRefGoogle Scholar
  13. 13.
    Bonnin MJ, Pepe PE, Clark PS, Kimball KT (1993) Distinct criteria for termination of resuscitation in the out-of-hospital setting. JAMA 270: 1457–1462PubMedCrossRefGoogle Scholar
  14. 14.
    Kellerman AL, Hackman BB, Somes G (1993) Predicting the outcome of unsuccessful prehospital advanced cardiac life support. JAMA 270: 1433–1436CrossRefGoogle Scholar
  15. 15.
    Pepe PE, Brown CG, Bonnin MJ, et al (1993) Prospective validation of criteria for onscene termination of resuscitation efforts after out-of-hospital cardiac arrest. Ann Emerg Med 22: 884–885CrossRefGoogle Scholar
  16. 16.
    Eisenberg MS, Cummins RO (1985) Termination of CPR in the prehospital arena. Ann Emerg Med 14: 1106–1107PubMedCrossRefGoogle Scholar
  17. 17.
    Schmidt TA, Harrahill MA (1995) Family response to out-of-hospital death. Acad Emerg Med 2: 513–518PubMedCrossRefGoogle Scholar
  18. 18.
    Pepe PE, Bonnin MJ, Mattox KL (1990) Regulating the scope of EMS. Prehosp Disast Med 5: 59–63Google Scholar
  19. 19.
    Pepe PE, Mattox KL, Duke JH, Fisher PB, Prentice FD (1993) The effect of full-time specialized physician supervision on the success of a large urban emergency medical services system. Crit Care Med 21: 1279–1286PubMedCrossRefGoogle Scholar
  20. 20.
    Pepe PE, Stewart RD (1986) The role of the physician in the prehospital setting. Ann Emerg Med 15: 1480–1483PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1996

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  • P. E. Pepe

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