Expected death and unwanted resuscitation in the prehospital setting.
OBJECTIVE
To determine the outcome, location, preexisting conditions, and resuscitation wishes of prehospital cardiac arrest patients.


METHODS
Retrospective review of paramedic and emergency medical technician run reports.


METHODS
Urban area with a two-tiered emergency medical services response system covering an area of 2,128 square miles and serving a population of 1,413,900 (in 1988).


METHODS
All prehospital cardiac arrest patients to which the King County, Washington, Emergency Medical Services (KCEMS) system responded to during a 12-month period. Unless decapitation, decomposition, or dependent lividity existed, all cardiac arrest patients in the KCEMS system received full resuscitative efforts.


METHODS
We analyzed run reports from 694 cardiac arrest patients, excluding all cardiac arrests from trauma, overdose, or drowning, or obvious signs of extended downtime such as decomposition or dependent lividity. We defined an unwanted resuscitation as a resuscitation attempt despite written or verbal requests by the patient, family, or private physician. We defined a patient as having severe, chronic disease if the run report listed one or more conditions associated with poor survival rates after inpatient CPR. These included cancer, cerebral vascular accident, dementia, renal failure, dialysis, AIDS, thoracic or abdominal aneurysms, cirrhosis, or if the patient was bedridden or was receiving chronic home nursing care.


RESULTS
Overall 16% (103 of 633) of all cardiac arrest patients survived to hospital discharge. Seven percent (47 of 633) of all cardiac arrest patients fit the unwanted resuscitation definition; 2% (one of 47) survived to hospital discharge. Twenty-five percent (158 of 633) of cardiac arrest patients fit the definition of severe chronic disease; 8% (12 of 158) survived to hospital discharge.


CONCLUSIONS
Severe chronic disease and unwanted resuscitation patients comprised one-third of all resuscitation attempts by KCEMS during a 12-month period. Both groups had lower survival rates compared to cardiac arrest patients who did not have severe chronic disease or indications of unwanted resuscitation.
Dull
S M
SM
Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque.
Graves
J R
JR
Larsen
M P
MP
Cummins
R O
RO
D016223:Advance Directives; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000401:mortality*; D015897:Comorbidity; D004632:Emergency Medical Services / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014505:Urban Population; D014861:Washington / Q000453:epidemiology