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How Do Prehospital Doctors Know When to Stop Administering CPR?

A recent study has revealed that prehospital doctors routinely make the decision to start (or continue) or withhold (or terminate) a cardiopulmonary resuscitation (CPR) based on situational and immediately available factors, such as patient age and resuscitation efforts by the emergency team.

Photo: Cardio-Pulmonary Resuscitation | InStyleHealth

The researchers did retrospective review of anonymized data from 1,525 patients with an average age of 74 years old, where 935 of them are men, who had an out-of-hospital cardiac arrest (OHCA). Relevant patient-related, process-related, and supplemental factors such as age, gender, physician response time, and comorbidities, were gathered. CPR was deemed withheld if efforts were not started or terminated within 3 minutes from arrival.

Majority (665) of the OHCA cases were encountered at home, while only 7% were encountered directly by emergency personnel. For the 39% of the cases, bystander CPR was administered. Resuscitation efforts were already ongoing in 81% of the subject patients.

In most cases (74%), prehospital care physicians attempted to or continued CPR efforts, while the remaining 26%, resuscitation was either withheld or terminated.

The multivariate logistic regression analysis unveiled that if a patient was already receiving resuscitation efforts by emergency personnel, CPR was >60 times more likely to be continued by the prehospital physician.

Patient’s first-monitored heart rhythm compared with asystole was a strong predictor of CPR initiation or continuation: pulseless electrical activity and ventricular fibrillation or pulseless ventricular tachycardia.

Meanwhile, the negative predictors included known malignancies and the physician unit’s response time. For complete details of the study, click here.


Source: Sci Rep 2021;11:5120

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