title: When is it futile for ambulance personnel to initiate cardiopulmonary resuscitation?
abstract: OBJECTIVE
  To determine whether patients with unexpected prehospital cardiac arrest could be identified in whom ambulance resuscitation attempts would be futile.
  
  
  METHODS
  Review of ambulance and hospital records; detailed review of automated external defibrillator rhythm strips of patients in whom no shock was advised.
  
  
  METHODS
  Scottish Ambulance Service; all cardiopulmonary resuscitation attempts after cardiorespiratory arrest during 1988-94 included in the Heartstart Scotland database.
  
  
  METHODS
  414 cardiorespiratory arrest patients with no pulse or breathing on arrival of ambulance personnel, no bystander cardiopulmonary resuscitation performed, and more than 15 minutes from time of arrest to arrival of ambulance. Patients were stratified into those with "shockable" and "non-shockable" rhythms.
  
  
  METHODS
  Return of spontaneous circulation, or survival to reach hospital alive, or survival to discharge, or all three.
  
  
  RESULTS
  No patient with a non-shockable rhythm who met the entry criteria for analysis survived a resuscitation attempt. Review of the defibrillator rhythm strips of these patients failed to find any case in which the tracing was deemed compatible with survival.
  
  
  CONCLUSIONS
  On the basis that it would be inappropriate to initiate vigorous resuscitation in patients who can be identified as "dead" and beyond help an algorithm was prepared to guide ambulance personnel.
authors.affiliation: Scottish Ambulance Service, National Headquarters, Edinburgh.
authors.forename: A K
authors.initials: AK
authors.lastname: Marsden
authors.forename: G A
authors.initials: GA
authors.lastname: Ng
authors.forename: K
authors.initials: K
authors.lastname: Dalziel
authors.forename: S M
authors.initials: SM
authors.lastname: Cobbe
mesh_terms: D000465:Algorithms; D000552:Ambulances; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D002985:Clinical Protocols; D004554:Electric Countershock; D004632:Emergency Medical Services / Q000592:standards*; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D018447:Medical Futility; D018579:Patient Selection; D037841:Pregnant People; D012606:Scotland; D028761:Withholding Treatment