Avoiding the futility of resuscitation

Purpose: To identify patients who should not have resuscitation started or continued. Design: Multi-disciplinary prospective study. Subjects: Two hundred forty-one consecutive patients with cardiopulmonary arrests from January 1995 to February 1997 were evaluated, of which 200 were studied. Methods: Subjects were studied for age, sex, arrest location, CPR duration, recovery from arrest, hospital discharge, 6 weeks' survival, sepsis and co-morbid conditions. Results: Overall 69 (34.5%) recovered from the arrest, 24 (12%) left the hospital, and 17 (8.5%) survived 6 weeks. Of inpatients, 13.7% (16/117) were alive at 6 weeks in contrast to 1.2% (1/83) of field/emergency room (ER) arrests. Sepsis did not lessen the immediate recovery rate; however, none of 25 septic patients survived hospitalization. Outcomes were not different between men and women or regular floor and ICU/CCU arrests. Age of survivors was the same as non-survivors. Survivors were resuscitated for 18.7 +/- 16.5 min and non-survivors 33.1 +/- 18.4 min (P=0.15). The initial rhythm of asystole or the presence of three or more co-morbid conditions had a negative prognosis. Conclusion: CPR survival is problematic, and it is especially poor in field/BR arrests. Emergency squads should terminate CPR for pulseless patients after communicating with the ER physician. Age is not a determinant of recovery or survival. Arrest outside of the hospital, sepsis, three or more co-morbid conditions, previous CPR, asystole or resuscitation for >25 min all decrease the chance of hospital discharge and survival. Instituting or continuing CPR in a great majority of these patients is futile. Families should be so advised. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.