CONTINUED CPR IN THE EMERGENCY ROOM IS NOT ALWAYS FUTILE

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CONTINUED CPR IN THE EMERGENCY ROOM IS NOT ALWAYS FUTILE.

When out-of-hospital cardiopulmonary resuscitation fails, continued CPR in the emergency department is considered to have very poor outcomes (see Journal Watch accession number 931005003 and JAMA 1993;270:1433-6, 1457- 62). This retrospective, single-site study from Basel, Switzerland reexamined the issue.

During a five-year span, the emergency medical systems (EMS) participated in 266 out-of-hospital arrests. CPR was successful in 24 patients, and 97 were declared dead at the scene. The other 145 patients were brought to the ED for ongoing resuscitation; of 141 for whom charts were available, 91 died in the ED. The remaining 50 (35 percent) were resuscitated, and 18 (13 percent) survived to hospital discharge after a mean stay of 44 days. At one year, 17 of the 18 were still alive, 16 with minimal or no neurologic damage. Survivors waited less time than nonsurvivors for the EMS to arrive after their arrest (6 vs. 9 minutes) and more often had CPR initiated by bystanders (44 vs. 15 percent). No patients with electromechanical dissociation or asystole noted in the field or in the ED survived.

Comment: Continuing CPR in the ED is not always futile. The authors attribute the higher survival rate (13 percent, as compared with less than 2 percent in past studies) to several factors, including their hospital's central location in a small city and high termination rates of CPR in the field, which resulted in the ED receiving fewer hopeless cases.

— CD Mulrow

Published in Journal Watch General Medicine November 29, 1994

Citation(s):

Schoenenberger RA et al. Survival after failed out-of-hospital resuscitation: are further therapeutic efforts in the emergency department futile?. Arch Intern Med 1994 Nov 14 154 2433-2437.

Medline abstract (Free)

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