Deciding when to stop resuscitation
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Terminating Resuscitation: Decision-Making Process
Introduction
Understanding When to Cease Resuscitation Efforts
In this discussion, we will explore the critical decision-making process involved in terminating resuscitation efforts. This decision is both possible and advisable when specific conditions are met, such as a patient being in asystole or experiencing a broad-complex PEA (Pulseless Electrical Activity) with a heart rate of fewer than 60 beats per minute for a duration exceeding 20 minutes despite ongoing resuscitation attempts.
Key Criteria for Terminating Resuscitation
Determining When Further Resuscitation is Futile
- Asystole or Broad-Complex PEA: When the patient is in asystole or a broad-complex PEA with a heart rate below 60 bpm for over 20 minutes despite resuscitative measures.
- Rhythm Assessment: Pause resuscitation to assess the cardiac rhythm, confirming the absence of electrical activity (asystole).
- Age Confirmation: Verify that the patient is not less than 18 years old.
- Exclusion of Specific Conditions: Confirm the absence of hypothermia, drowning, traumatic cardiac arrest due to penetrating injuries, and pregnancy.
- Unanimous Decision: Ensure agreement among the resuscitation team to stop further resuscitation efforts.
Making the Difficult Decision
Considering the Patient's Best Interests
Terminating resuscitation is a challenging decision, especially in cases involving younger patients. However, when a patient remains in asystole for over 20 minutes without meeting specific criteria, it becomes necessary to cease resuscitation efforts. This decision aligns with established protocols and aims to allocate resources effectively and prioritise patients with a higher likelihood of positive outcomes.
It's essential to consider the specific criteria for termination:
- All children under 18 years old must be transported to a Resus department.
- Patient care continues until normothermia is achieved for those with hypothermia or drowning.
- Patients with penetrating trauma (e.g., stab or gunshot wounds) should be transported to a hospital where they can receive blood products.
- In cases involving pregnant patients, resuscitation focuses on the mother's well-being while aiming to save the baby as well.