When is it futile for ambulance personnel to initiate cardiopulmonary resuscitation?

Abstract

Hewlett Packard laser printer. Dot matrix printers are cheapest, but their print quality is poor and they are very noisy. Dot matrix printers are, however, well suited to printing on tractor feed paper and multipart forms.All printers can print on to A4 paper, but you should also ask whether the printer you are considering is capable ofprinting on to acetate sheets for overhead presentations and on to different sizes of paper. Many general practitioners prefer letters printed on A5 rather than A4 paper as A5 fits more easily into standard records. Users of portable computers may wish to consider a compact battery operated printer which allows printing on the move. Before choosing a printer ask to see an example ofits print quality and compare this with samples from other makes. Conclusions-On the basis that it would be inappropriate to initiate vigorous resuscitation in patients who can be identified as "dead" and beyond help an algorithm was prepared to guide ambulance personnel.

Comparison of Termination-of-Resuscitation Guidelines for Basic Life Support: Defibrillator Providers in Out-of-Hospital Cardiac Arrest

“…However, the specificity and transport rates of the 3 rules varied greatly (Table 2). According to the original reports by Marsden et al, 8 Petrie, 9 and Verbeek et al, 10 these rules all had 100% negative predictive values, meaning that no patient would have been pronounced dead in the field who might eventually have survived to discharge. However, with a larger cohort of patients, we found this not to be true.…”

“…However, with a larger cohort of patients, we found this not to be true. There was 1 patient in this category for Petrie, 9 3 for Verbeek et al, 10 and 1 for Marsden et al 8 Although the rules might still meet the less than 1% likelihood of benefit according to the definition of futility by Schneiderman et al, 27 this poses an ethical and possibly legal dilemma. [18][19][20]28,29 The functional status of survivors is also an issue, and more research is needed into possible public reactions to field termination of resuscitation by BLS defibrillators.…”

“…Suggestions have been made that termination of resuscitation can be implemented for BLS defibrillator systems as well. Three such guidelines have been proposed by Marsden et al, 8 Petrie,9 and Verbeek et al 10 ( Figure 1). To date, comparatively little research has been published about termination of resuscitation for BLS compared to ALS systems.…”

“…To date, comparatively little research has been published about termination of resuscitation for BLS compared to ALS systems. We also note that in North America, 11 the UK, 8,10,12 and around the world, EMT defibrillators may make up the predominant responders in many EMS systems. In 1995, Marsden et al 8 proposed a termination of resuscitation algorithm based on a review of 414 cardiac arrest patients.…”

Clinical Decision Rules for Termination of Resuscitation in Out-of-Hospital Cardiac Arrest

“…Retrospective validation using a cohort study from 1988 to 2003. Three previously derived guidelines were externally validated using cohort data from the previously described BLS-TOR rule; the Petrie et al rule, which recommends termination of resuscitation if the initial rhythm is asystole and the EMS response time is Ͼ 8 min; and the Marsden et al rule, which recommends termination of resuscitation if the initial rhythm is not shockable, there is no ROSC, and no evidence of CPR within the past 15 min (5,7,8).…”