Survival After Failed Out-of-Hospital Resuscitation: Are Further Therapeutic Efforts in the Emergency Department Futile?

doi:10.1001/archinte.1994.00420210069008

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Vol. 154 No. 21, 14 November 1994

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Survival After Failed Out-of-Hospital Resuscitation

Are Further Therapeutic Efforts in the Emergency Department Futile?

Ronald A. Schoenenberger, MD; Martin von Planta, MD; Irene von Planta, MD

Arch Intern Med. 1994;154(21):2433-2437.

Abstract

Background
Because of extremely poor outcomes, the practice of continuingcardiopulmonary resuscitation in hospital emergency departmentsafter unsuccessful out-of-hospital cardiopulmonary resuscitationhas been strongly questioned. Before revising our institutionalguidelines according to previous pessimistic reports we wishedto review our own experience with this practice.

Methods
The case histories of 141 consecutive victims of witnessed cardiacarrest brought to the emergency department with ongoing cardiopulmonaryresuscitation were reviewed. The emergency medical system wastwo-tiered and was based on the emergency department of a singleuniversity hospital. The first tier, staffed with emergencymedical technicians, provided only basic cardiac life support.The second, physician-staffed tier provided advanced cardiaclife support and was allowed to terminate resuscitation in thefield. Rates of successful resuscitation, survival to dischargeand after 1 year, and the cerebral performance of resuscitatedand surviving patients were determined.

Results
Ninety-one patients (65%) died in the emergency department;50 (35%) were resuscitated and admitted. Thirty-two patients(23%) died in the hospital, 18 (13%; 95% confidence interval,8% to 20%) survived to discharge. Sixteen survivors showed noor only mild neurologic impairment at discharge. Seventeen patientswere alive 1 year later. Bystander resuscitation, short intervalsto initiation of resuscitation, and ventricular fibrillationat emergency department entry were significantly associatedwith survival.

Conclusions
Institutional guidelines for the decision whether to continueresuscitation after failed out-of-hospital efforts should bebased on an analysis of the characteristics and results of thelocal emergency medical system. Continuing efforts in the hospitalmay not be inevitably futile.

(Arch Intern Med. 1994;154:2433-2437)

Author Affiliations

From the Department of Internal Medicine, University Hospital, Basel, Switzerland. Dr Schoenenberger is now with the Division of Clinical Epidemiology, Brigham and Women's Hospital, Boston, Mass.

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