Paramedics should make call on resuscitation for cardiac arrest: study

It's time to let paramedics decide when enough is enough while resuscitating people with cardiac arrests, emergency medicalresearchers say.

By the time paramedics get to patients in cardiac arrest, it's too late to save most. Currently, fewer than four out of 100 survive.

Most paramedics in Canada are compelled to transport all of these patients to hospital, even though it may be medically futile.

Researchers tracked more than 1,200 Ontario adultswho sufferedcardiac arrest, looking for a way to predict the small number who would live if taken to hospital and the large majority who would die anyway.

Bringing such patients to the hospital is not only costly and unnecessary, it can be more stressful for the family, said the study's lead author, Dr. Richard Verbeek, an emergency physician at Toronto's Sunnybrook & William Osler Hospital.

"Families are much more accepting and their grieving process is actually much shorter when there's a pronouncement done in the home and we stop resuscitation in the home," said Verbeek.

Unnecessary resuscitation a burden

The team's three-point guideline ismeant to help paramedics predict which patients won't survive, to avoid wasting precious resources. Stopping treatmentwas advised if a pulse couldn't be restored, if the defibrillator determined that an electric shock shouldn't be given, and if the cardiac arrest had not been witnessed by a rescue worker.

Transporting patients who aren't likely to survive puts the providersand public at risk from road hazards, increases costs, and may reduce the availability of paramedic and emergency medical services for other patients with better prospects, saidDr. Gordon Ewy of the University of Arizona Sarver Heart Center in a journal commentary.

Verbeek's teamfound four patients out of 1,240 who would have been declared dead if the guidelines had been strictly followed, but in fact lived. One had severe brain damage.

Given the finding and the need for medical judgment, the researchers calledtheir prediction rule to be a guideline, not an obligatory policy.

The resultsare important, but applying the guideline will bedifficult for some, said Dr. David Petrie, an emergency physician at Queen Elizabeth II Health Sciences Centre in Halifax.

"To think that we won't continue maximum resuscitative efforts is a hard one to swallow for that individual patient," said Petrie.