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Medical futility in asystolic out‐of‐hospital cardiac arrest
Author(s) -
VÄYRYNEN T.,
KUISMA M.,
MÄÄTTÄ T.,
BOYD J.
Publication year - 2008
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2007.01461.x
Subject(s) - asystole , medicine , basic life support , advanced life support , resuscitation , cardiopulmonary resuscitation , emergency medical services , emergency medicine , retrospective cohort study , population , anesthesia , environmental health
Objectives: To study the factors associated with short‐ and long‐term survival after asystolic out‐of‐hospital cardiac arrest, with a reference to medical futility. Methods: This is a retrospective observational study conducted in Helsinki, Finland during 1 January 1997 to 31 December 2005. All out‐of‐hospital cardiac arrests were prospectively registered in the cardiac arrest database. Of 3291 arrests, 1455 had asystole as the first registered rhythm. These patients represent the study population. Results: A short time interval to the initiation of advanced life support (ALS) was associated with a long‐term benefit, but a short first responding unit (FRU) response time had only a short‐term benefit. Conversion of asystole into a shockable rhythm provided only a short‐term benefit. The prognosis was poor if the FRU response time was over 10 min or the ALS response time was over 11 min in bystander‐witnessed arrests, and if the duration of resuscitation was over 8 min in emergency medical services (EMS)‐witnessed arrests. Bystander‐CPR was associated with increased 30‐day mortality. The 30‐day survival rate after an unwitnessed arrest ( n =548) was 0.5%. All survivors in this group were either hypothermic or were victims of near‐drowning. Conclusions: Resuscitation should be withheld in cases of unwitnessed asystole, excluding cases of hypothermia and near‐drowning. The prognosis is poor if the FRU response time is over 10 min or the ALS response time is over 10–15 min in bystander‐witnessed arrests. The decision of whether or not to attempt resuscitation should not be influenced by the presence of bystander‐CPR. Early initiation of ALS should be prioritised in the treatment of out‐of‐hospital asystole.