Assessment of futility in out‐of‐hospital cardiac arrest

• Published in: Acta anaesthesiologica Scandinavica Vol. 61; no. 10; pp. 1334 - 1344
• Main Authors: Setälä, P., Hoppu, S., Virkkunen, I., Yli‐Hankala, A., Kämäräinen, A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.11.2017
• Subjects: Aged; Aged, 80 and over; Brain injury; Cardiopulmonary Resuscitation; CPR; Emergency medical services; Female; Health services; Heart; Heart diseases; Humans; Logistic Models; Male; Medical prognosis; Middle Aged; Out-of-Hospital Cardiac Arrest - mortality; Prospective Studies; Resuscitation; Rhythm; Survival
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.12966

Background Our aim was to evaluate the impact of futile resuscitation attempts to the outcome calculations of attempted resuscitation in out‐of‐hospital cardiac arrest (OHCA). Defined as partial resuscitations, we focused on a subgroup of patients in whom cardiopulmonary resuscitation (CPR) was initiated, but further efforts were soon abandoned due to evidence of futility. Methods We conducted this study using the Utstein template during a 12‐month study period. We compared the event characteristics between full and partial resuscitation attempts and determined the incidence, survival and neurological outcome. Results Emergency Medical Services (EMS) attended a total of 314 OHCA cases. In 34 cases, resuscitation was not attempted due to futility. Seventy‐four cases were partial resuscitation attempts where resuscitation was soon discontinued due to dismal prognostic factors. Partial attempts were associated with an unwitnessed OHCA, prolonged downtime, end‐stage malignant disease, multiple trauma, asystole or pulseless electrical activity as the initial rhythm, and a first responding unit being the first unit on the scene (P < 0.05, respectively). The calculation of survival to hospital discharge rate was 14% and increased 5% when partial resuscitation attempts were excluded from the analysis. Seventy‐four percentage had a Cerebral Performance Category 1–2 at hospital discharge. Shockable initial rhythm, public location and bystander CPR had a positive impact on survival. Conclusions Resuscitative efforts were considered futile in 11% of cases and resuscitation was discontinued due to evidence of futility in additional 24% cases based on additional information. Terminating resuscitation should be identified as a separate subgroup of OHCA cases to better reflect the outcome.