When should cardiac arrest patients be resuscitated outside hospital?


When should cardiac arrest patients be resuscitated outside hospital?


Canadian researchers have devised guidelines aimed at helping EMTs (emergency medical technicians) decide when to halt resuscitation procedures for cardiac arrest patients outside hospital.

The guidelines have been published in The New England Journal of Medicine (NEJM), August 3 issue.

Dr. Laurie Morrison, lead author, University of Toronto, Canada, explained that the guidelines would help paramedics and doctors decide which patients have the best chance of surviving out-of-hospital cardiac arrest.

Dr. Morrison said "Most people die in out-of-hospital cardiac arrest. The survival rate is very low, and we want to be able to identify where further resuscitation is futile and where we could instead support the family. For those that survival is a possibility, we want to get them to the emergency department.

As all health professionals know, guidelines must be adapted to cost constraints and geography. These new guidelines should be seen as information that could be used depending on several factors the health care professional finds himself/herself in when faced with a cardiac arrest patient outside hospital.

In the USA advance-level paramedics have guidelines, EMTs don't. Often patients with no chance of survival (futile cases) are taken to emergency departments. Many parts of the USA only have EMTs in their emergency departments.

The new guidelines suggest that resuscitation efforts should stop if:

-- Before transportation, no return of spontaneous circulation took place

-- The patient received no shock before transportation started

-- The EMS staff did not eyewitness the cardiac arrest

The authors of the new guidelines studied records of 1,240 patients in 24 Canadian emergency medical systems. All adult cardiac arrest patients were treated by EMTs trained to use automated external defibrillators. All the patients were followed-up.

They found that the guidelines were extremely accurate - predicting death in 99.5% of cases (when termination of resuscitation efforts was recommended).

Currently, 100% of patients are taken to an emergency rooms. By following these guidelines only 37.4% of patients would be taken to an emergency room.

Those in favour of the guidelines say they would lead to better use of resources for other more viable' patients as well as for the families of futile' cases. In the case of families, instead of having them rush to an emergency hospital department and then having to grieve in a very public place, resources could be used to prevent this - resources could be better used to help grieving families. There is another benefit for paramedics and EMTs - they would be less exposed to HIV or hepatitis.

What is cardiac arrest?

The sudden loss of function of the heart. There is a sudden disturbance in the heart's rhythm. Either the heart stops beating completely, or does not beat enough to keep the patient alive. Both people with and without heart disease can have a cardiac arrest.

Validation of a Rule for Termination of Resuscitation in Out-of-Hospital Cardiac Arrest

Laurie J. Morrison, M.D., Laura M. Visentin, B.Sc., Alex Kiss, Ph.D., Rob Theriault, Don Eby, M.D., Marian Vermeulen, B.Sc.N., M.H.Sc., Jonathan Sherbino, M.D., P. Richard Verbeek, M.D., for the TOR Investigators

New England Journal of Medicine, August 3 Issue

Click Here To See Abstract

Editor: womenhealthsecret.com


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