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THE DIM PROGNOSIS OF FAILED PREHOSPITAL CPR.

Cardiopulmonary resuscitation (CPR) is often practiced when the chance of success is low (see Journal Watch accession number 910625007), such as when the initial rhythm is electromechanical dissociation or asystole, or continued when initial CPR has been unsuccessful for 15 minutes or more. Such prolonged use of CPR is increasingly being challenged.

A team from Rhode Island Hospital studied the records of 185 patients who continued to receive CPR in the emergency department after prehospital CPR by rescue personnel had been unsuccessful. By the time patients reached the emergency department, electromechanical dissociation and asystole were the primary cardiac rhythms noted. Emergency- department CPR was successful in 16 patients (9 percent), who then were admitted to the hospital. Their mean resuscitation time was 19 minutes.

Despite successful resuscitation in the emergency department, none of the patients were discharged alive. All remained comatose during the last hours of their lives, except for one patient who regained consciousness but remained intubated. The mean lengths of stay in the intensive-care unit and in the hospital were 2.3 days and 12.6 days, respectively, and charges averaged $11,307 per patient. The authors and an editorialist conclude that it is generally both inhumane and wasteful to continue resuscitating a victim of cardiac arrest when prehospital resuscitation has failed.

— ALK

Published in Journal Watch General Medicine November 19, 1991

Citation(s):

Weaver WD. Resuscitation outside the hospital -- what's lacking. N Engl J Med 1991 Nov 14 325 1437-1439.

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Gray WA et al. Unsuccessful emergency medical resuscitation -- are continued efforts in the emergency department justified. N Engl J Med 1991 Nov 14 325 1393-1398.

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