Outcome of out-of-hospital cardiac arrest--why do physicians withhold resuscitation attempts?
OBJECTIVE
To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts.


METHODS
Prospective collection of data during 12 months by the anaesthesiologists from the Advanced Life Support unit (ALS) of the Emergency Medical Service (EMS) according to the Utstein template.


RESULTS
In total, 499 OHCA were analysed and 266 patients received cardiopulmonary resuscitation (CPR) by the ALS unit. Initial rhythm was ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) in 35%, asystole in 38%, and other rhythm in 27%. Of the 266 treated patients, 83 (31%) patients had a spontaneous circulation on admission to hospital. Survival to discharge from hospital was 6.2% for all cases of OHCA, 11.7% for all 266 treated patients, and 20.5% for patients with witnessed cardiac arrest and presumed cardiac aetiology in VF. On arrival, the physician decided in 233 cases to withhold or discontinue CPR. The explanation for this was prolonged anoxia (74%), terminal cancer (8%), and severe trauma (7%). The most common incident locations were the patient's home and nursing homes. These locations were more common in the group where resuscitation was not attempted and these patients were older and the proportions of females and asystole were significantly higher. Bystander CPR was provided in 82 (16%) overall, but only in 8 (3%) in the group where resuscitation was not attempted.


CONCLUSIONS
Survival to discharge from hospital in all cases of OHCA was 6.2% but 20.5% in witnessed, presumed cardiac aetiology in VF. The decision to withhold resuscitation was based upon presumed prolonged anoxia in the majority of cases.
Horsted
Tina I
TI
Department of Anaesthesia, Centre of Head and Orthopaedics 4231, Copenhagen University Hospital, Rigshospitalet DK-2100, Copenhagen, Denmark.
Rasmussen
Lars S
LS
Lippert
Freddy K
FK
Nielsen
Søren L
SL
D000293:Adolescent; D000328:Adult; D022561:Advanced Cardiac Life Support; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000628:therapy*; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011446:Prospective Studies; D016414:Resuscitation Orders; D015996:Survival Rate; D016896:Treatment Outcome