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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
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: 1838–1843
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: 53–55
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: 1832–1847
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: 1181–1186
Guidelines for cardiopulmonary resuscitation and emergency cardiac care (1992) Emergency Care Committee, Subcommittee on ACLS, American Heart Association. JAMA 268: 2171–2302
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: 2282–2288
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)
Marsden AK, Ng GA, Dalziel K, Cobbe SM (1995) When is it futile for ambulance personnel to initiate cardiopulmonary resuscitation? Br Med J 311: 49–51
Bonnin MJ, Pepe PE, Clark PS (1993) Survival in the elderly following out-of-hospital cardiac arrest. Crit Care Med 21: 1645–1651
Longstreth WT, Cobb LA, Fahrenbruch CE, Copass MK (1990) Does age affect outcomes of out-of-hospital cardiopulmonary resuscitation? JAMA 264: 2109–2110
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: 145–150
Kellerman AL (1993) Criteria for dead-on-arrivals, prehospital termination of CPR and do-not-resuscitate orders. Ann Emerg Med 22: 47–51
Bonnin MJ, Pepe PE, Clark PS, Kimball KT (1993) Distinct criteria for termination of resuscitation in the out-of-hospital setting. JAMA 270: 1457–1462
Kellerman AL, Hackman BB, Somes G (1993) Predicting the outcome of unsuccessful prehospital advanced cardiac life support. JAMA 270: 1433–1436
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: 884–885
Eisenberg MS, Cummins RO (1985) Termination of CPR in the prehospital arena. Ann Emerg Med 14: 1106–1107
Schmidt TA, Harrahill MA (1995) Family response to out-of-hospital death. Acad Emerg Med 2: 513–518
Pepe PE, Bonnin MJ, Mattox KL (1990) Regulating the scope of EMS. Prehosp Disast Med 5: 59–63
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: 1279–1286
Pepe PE, Stewart RD (1986) The role of the physician in the prehospital setting. Ann Emerg Med 15: 1480–1483
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1996 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Pepe, P.E. (1996). Resuscitation Decisions. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine. Yearbook of Intensive Care and Emergency Medicine, vol 1996. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-80053-5_65
Download citation
DOI: https://doi.org/10.1007/978-3-642-80053-5_65
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-60552-2
Online ISBN: 978-3-642-80053-5
eBook Packages: Springer Book Archive