Document Detail

Expected death and unwanted resuscitation in the prehospital setting.
MedLine Citation:
PMID:  8185118     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: To determine the outcome, location, preexisting conditions, and resuscitation wishes of prehospital cardiac arrest patients. DESIGN: Retrospective review of paramedic and emergency medical technician run reports. SETTING: Urban area with a two-tiered emergency medical services response system covering an area of 2,128 square miles and serving a population of 1,413,900 (in 1988). PARTICIPANTS: All prehospital cardiac arrest patients to which the King County, Washington, Emergency Medical Services (KCEMS) system responded to during a 12-month period. Unless decapitation, decomposition, or dependent lividity existed, all cardiac arrest patients in the KCEMS system received full resuscitative efforts. MEASUREMENTS: We analyzed run reports from 694 cardiac arrest patients, excluding all cardiac arrests from trauma, overdose, or drowning, or obvious signs of extended downtime such as decomposition or dependent lividity. We defined an unwanted resuscitation as a resuscitation attempt despite written or verbal requests by the patient, family, or private physician. We defined a patient as having severe, chronic disease if the run report listed one or more conditions associated with poor survival rates after inpatient CPR. These included cancer, cerebral vascular accident, dementia, renal failure, dialysis, AIDS, thoracic or abdominal aneurysms, cirrhosis, or if the patient was bedridden or was receiving chronic home nursing care. MAIN RESULTS: Overall 16% (103 of 633) of all cardiac arrest patients survived to hospital discharge. Seven percent (47 of 633) of all cardiac arrest patients fit the unwanted resuscitation definition; 2% (one of 47) survived to hospital discharge. Twenty-five percent (158 of 633) of cardiac arrest patients fit the definition of severe chronic disease; 8% (12 of 158) survived to hospital discharge. CONCLUSION: Severe chronic disease and unwanted resuscitation patients comprised one-third of all resuscitation attempts by KCEMS during a 12-month period. Both groups had lower survival rates compared to cardiac arrest patients who did not have severe chronic disease or indications of unwanted resuscitation.
S M Dull; J R Graves; M P Larsen; R O Cummins
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  23     ISSN:  0196-0644     ISO Abbreviation:  Ann Emerg Med     Publication Date:  1994 May 
Date Detail:
Created Date:  1994-06-14     Completed Date:  1994-06-14     Revised Date:  2004-11-18    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  997-1002     Citation Subset:  AIM; E; IM    
Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque.
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MeSH Terms
Advance Directives*
Cardiopulmonary Resuscitation / statistics & numerical data,  utilization*
Chronic Disease / mortality*
Emergency Medical Services / legislation & jurisprudence,  statistics & numerical data,  utilization*
Health Services Misuse / statistics & numerical data*
Heart Arrest / mortality*,  therapy*
Hospital Mortality
Outcome Assessment (Health Care)
Patient Admission / statistics & numerical data
Patient Discharge / statistics & numerical data
Retrospective Studies
Severity of Illness Index
Survival Rate
Urban Population
Washington / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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