Morning Report: 11/15/2013

Thanks to Dr. LoCascio for today’s Morning Report!

Out-of-Hospital Cardiac Arrest

AMA Council on Ethical and Judicial Affairs states that CPR may be withheld, even if requested, “when efforts to resuscitate a patient are judged by the treating physician to be futile.”

ACEP “physicians are under no ethical obligation to render treatments that they judge have no realistic likelihood of medical benefit to the patient.”

Outcome of resuscitation for cardiac arrests depends on multiple factors

Overall survival of out of hospital cardiac arrest to hospital discharge 9.5% 2013 (American Heart Association)

Factors Predictive of Improved Outcomes after Cardiac Arrest

Witnessed arrest

Brief down time and early ACLS

Ventricular arrhythmias

Bystander CPR

Return of spontaneous circulation in response to ACLS protocols

Factors that are associated with a poor outcome following out-of-hospital sudden cardiac arrest:

Absence of any vital signs
Sepsis
CVA with severe neurologic deficit
Cancer or Alzheimer disease
History of more than two chronic diseases
A history of cardiac disease
Prolonged CPR more than five minutes

Japanese study of almost 400,000 patients with non-traumatic OHCA from 2005-2009, prospective database. Neurologic outcome was defined in terms of Cerebral Performance Category ( 1 good, 4 vegetative state, 5 death)

Primary end point survival with favorable neurologic outcome at 1 month
Secondary endpoint was survival at 1 month

mr11152013p1

Goto Y, Meda T, Goto Y. Decision-tree model for predicting outcomes after out-of-hospital cardiac arrest in the emergency department. Crit Care. 2013; 17(4):R133.