Resuscitation in the out-of-hospital setting: Medical futility criteria for on-scene pronouncement of death

Paul E. Pepe, Robert A. Swor, Joseph P. Ornato, Edward M. Racht, Donald M. Blanton, John K. Griswell, Thomas Blackwell, James Dunford

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

The complete and irreversible cessation of life is often difficult to determine with complete confidence in the dynamic environment of out-of-hospital emergency care. As a result, resuscitation efforts often are initiated and maintained by emergency medical services (EMS) providers in many hopeless situations. Medical guidelines are reviewed here to aid EMS organizations with respect to decisions about: 1) initiating or waiving resuscitation efforts; 2) the appropriate duration of resuscitation efforts; and 3) recommended procedures for on-scene or prehospital pronouncement of death (termination of resuscitation). In cases of nontraumatic cardiac arrest, few unassailable criteria, other than certain physical signs of irreversible tissue deterioration, exist for determining medical futility at the initial encounter with the patient. Thus, the general medical recommendation is to attempt to resuscitate all patients, adult or child, in the absence of rigor mortis or dependent lividity. Conversely, well-founded guidelines now are available for decisions regarding termination of resuscitation in such patients once they have received a trial of advanced cardiac life support. In practice, however, the final decision to proceed with onscene pronouncement of death for these patients may be determined more by family and provider comfort levels and the specific on-scene environment. For patients with posttraumatic circulatory arrest, the type of injury (blunt or penetrating), the presence of vital signs, and the electrocardiographic findings are used to determine the futility of initiating or continuing resuscitation efforts. In general, patients who are asystolic on-scene are candidates for on-scene pronouncement, regardless of mechanism. With a few exceptions, blunt trauma patients with a clearly associated mechanism of lethal injury are generally candidates for immediate cessation of efforts once they lose their pulses and respirations. Regardless of the medical futility criteria, specialized training of EMS providers and targeted related testing of operational issues need to precede field implementation of on-scene pronouncement policies. Such policies also must be modified and adapted for local issues and resources. In addition, although the current determinations of medical futility, as delineated here, are important to establish for societal needs, the individual patient's right to live must be kept in mind always as new medical advances are developed.

Original languageEnglish (US)
Pages (from-to)79-87
Number of pages9
JournalPrehospital Emergency Care
Volume5
Issue number1
StatePublished - 2001

Fingerprint

Medical Futility
Resuscitation
Emergency Medical Services
Rigor Mortis
Advanced Cardiac Life Support
Guidelines
Nonpenetrating Wounds
Vital Signs
Wounds and Injuries
Patient Rights
Heart Arrest
Respiration
Organizations

Keywords

  • Cardiac arrest
  • Death
  • Field pronouncement
  • Futility
  • Pronouncement of death
  • Resuscitation
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Pepe, P. E., Swor, R. A., Ornato, J. P., Racht, E. M., Blanton, D. M., Griswell, J. K., ... Dunford, J. (2001). Resuscitation in the out-of-hospital setting: Medical futility criteria for on-scene pronouncement of death. Prehospital Emergency Care, 5(1), 79-87.

Resuscitation in the out-of-hospital setting : Medical futility criteria for on-scene pronouncement of death. / Pepe, Paul E.; Swor, Robert A.; Ornato, Joseph P.; Racht, Edward M.; Blanton, Donald M.; Griswell, John K.; Blackwell, Thomas; Dunford, James.

In: Prehospital Emergency Care, Vol. 5, No. 1, 2001, p. 79-87.

Research output: Contribution to journalArticle

Pepe, PE, Swor, RA, Ornato, JP, Racht, EM, Blanton, DM, Griswell, JK, Blackwell, T & Dunford, J 2001, 'Resuscitation in the out-of-hospital setting: Medical futility criteria for on-scene pronouncement of death', Prehospital Emergency Care, vol. 5, no. 1, pp. 79-87.
Pepe PE, Swor RA, Ornato JP, Racht EM, Blanton DM, Griswell JK et al. Resuscitation in the out-of-hospital setting: Medical futility criteria for on-scene pronouncement of death. Prehospital Emergency Care. 2001;5(1):79-87.
Pepe, Paul E. ; Swor, Robert A. ; Ornato, Joseph P. ; Racht, Edward M. ; Blanton, Donald M. ; Griswell, John K. ; Blackwell, Thomas ; Dunford, James. / Resuscitation in the out-of-hospital setting : Medical futility criteria for on-scene pronouncement of death. In: Prehospital Emergency Care. 2001 ; Vol. 5, No. 1. pp. 79-87.
@article{1622bfd846dd4515bcfe34954c24ee67,
title = "Resuscitation in the out-of-hospital setting: Medical futility criteria for on-scene pronouncement of death",
abstract = "The complete and irreversible cessation of life is often difficult to determine with complete confidence in the dynamic environment of out-of-hospital emergency care. As a result, resuscitation efforts often are initiated and maintained by emergency medical services (EMS) providers in many hopeless situations. Medical guidelines are reviewed here to aid EMS organizations with respect to decisions about: 1) initiating or waiving resuscitation efforts; 2) the appropriate duration of resuscitation efforts; and 3) recommended procedures for on-scene or prehospital pronouncement of death (termination of resuscitation). In cases of nontraumatic cardiac arrest, few unassailable criteria, other than certain physical signs of irreversible tissue deterioration, exist for determining medical futility at the initial encounter with the patient. Thus, the general medical recommendation is to attempt to resuscitate all patients, adult or child, in the absence of rigor mortis or dependent lividity. Conversely, well-founded guidelines now are available for decisions regarding termination of resuscitation in such patients once they have received a trial of advanced cardiac life support. In practice, however, the final decision to proceed with onscene pronouncement of death for these patients may be determined more by family and provider comfort levels and the specific on-scene environment. For patients with posttraumatic circulatory arrest, the type of injury (blunt or penetrating), the presence of vital signs, and the electrocardiographic findings are used to determine the futility of initiating or continuing resuscitation efforts. In general, patients who are asystolic on-scene are candidates for on-scene pronouncement, regardless of mechanism. With a few exceptions, blunt trauma patients with a clearly associated mechanism of lethal injury are generally candidates for immediate cessation of efforts once they lose their pulses and respirations. Regardless of the medical futility criteria, specialized training of EMS providers and targeted related testing of operational issues need to precede field implementation of on-scene pronouncement policies. Such policies also must be modified and adapted for local issues and resources. In addition, although the current determinations of medical futility, as delineated here, are important to establish for societal needs, the individual patient's right to live must be kept in mind always as new medical advances are developed.",
keywords = "Cardiac arrest, Death, Field pronouncement, Futility, Pronouncement of death, Resuscitation, Trauma",
author = "Pepe, {Paul E.} and Swor, {Robert A.} and Ornato, {Joseph P.} and Racht, {Edward M.} and Blanton, {Donald M.} and Griswell, {John K.} and Thomas Blackwell and James Dunford",
year = "2001",
language = "English (US)",
volume = "5",
pages = "79--87",
journal = "Prehospital Emergency Care",
issn = "1090-3127",
publisher = "Informa Healthcare",
number = "1",

}

TY - JOUR

T1 - Resuscitation in the out-of-hospital setting

T2 - Medical futility criteria for on-scene pronouncement of death

AU - Pepe, Paul E.

AU - Swor, Robert A.

AU - Ornato, Joseph P.

AU - Racht, Edward M.

AU - Blanton, Donald M.

AU - Griswell, John K.

AU - Blackwell, Thomas

AU - Dunford, James

PY - 2001

Y1 - 2001

N2 - The complete and irreversible cessation of life is often difficult to determine with complete confidence in the dynamic environment of out-of-hospital emergency care. As a result, resuscitation efforts often are initiated and maintained by emergency medical services (EMS) providers in many hopeless situations. Medical guidelines are reviewed here to aid EMS organizations with respect to decisions about: 1) initiating or waiving resuscitation efforts; 2) the appropriate duration of resuscitation efforts; and 3) recommended procedures for on-scene or prehospital pronouncement of death (termination of resuscitation). In cases of nontraumatic cardiac arrest, few unassailable criteria, other than certain physical signs of irreversible tissue deterioration, exist for determining medical futility at the initial encounter with the patient. Thus, the general medical recommendation is to attempt to resuscitate all patients, adult or child, in the absence of rigor mortis or dependent lividity. Conversely, well-founded guidelines now are available for decisions regarding termination of resuscitation in such patients once they have received a trial of advanced cardiac life support. In practice, however, the final decision to proceed with onscene pronouncement of death for these patients may be determined more by family and provider comfort levels and the specific on-scene environment. For patients with posttraumatic circulatory arrest, the type of injury (blunt or penetrating), the presence of vital signs, and the electrocardiographic findings are used to determine the futility of initiating or continuing resuscitation efforts. In general, patients who are asystolic on-scene are candidates for on-scene pronouncement, regardless of mechanism. With a few exceptions, blunt trauma patients with a clearly associated mechanism of lethal injury are generally candidates for immediate cessation of efforts once they lose their pulses and respirations. Regardless of the medical futility criteria, specialized training of EMS providers and targeted related testing of operational issues need to precede field implementation of on-scene pronouncement policies. Such policies also must be modified and adapted for local issues and resources. In addition, although the current determinations of medical futility, as delineated here, are important to establish for societal needs, the individual patient's right to live must be kept in mind always as new medical advances are developed.

AB - The complete and irreversible cessation of life is often difficult to determine with complete confidence in the dynamic environment of out-of-hospital emergency care. As a result, resuscitation efforts often are initiated and maintained by emergency medical services (EMS) providers in many hopeless situations. Medical guidelines are reviewed here to aid EMS organizations with respect to decisions about: 1) initiating or waiving resuscitation efforts; 2) the appropriate duration of resuscitation efforts; and 3) recommended procedures for on-scene or prehospital pronouncement of death (termination of resuscitation). In cases of nontraumatic cardiac arrest, few unassailable criteria, other than certain physical signs of irreversible tissue deterioration, exist for determining medical futility at the initial encounter with the patient. Thus, the general medical recommendation is to attempt to resuscitate all patients, adult or child, in the absence of rigor mortis or dependent lividity. Conversely, well-founded guidelines now are available for decisions regarding termination of resuscitation in such patients once they have received a trial of advanced cardiac life support. In practice, however, the final decision to proceed with onscene pronouncement of death for these patients may be determined more by family and provider comfort levels and the specific on-scene environment. For patients with posttraumatic circulatory arrest, the type of injury (blunt or penetrating), the presence of vital signs, and the electrocardiographic findings are used to determine the futility of initiating or continuing resuscitation efforts. In general, patients who are asystolic on-scene are candidates for on-scene pronouncement, regardless of mechanism. With a few exceptions, blunt trauma patients with a clearly associated mechanism of lethal injury are generally candidates for immediate cessation of efforts once they lose their pulses and respirations. Regardless of the medical futility criteria, specialized training of EMS providers and targeted related testing of operational issues need to precede field implementation of on-scene pronouncement policies. Such policies also must be modified and adapted for local issues and resources. In addition, although the current determinations of medical futility, as delineated here, are important to establish for societal needs, the individual patient's right to live must be kept in mind always as new medical advances are developed.

KW - Cardiac arrest

KW - Death

KW - Field pronouncement

KW - Futility

KW - Pronouncement of death

KW - Resuscitation

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=0035182196&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035182196&partnerID=8YFLogxK

M3 - Article

C2 - 11194075

AN - SCOPUS:0035182196

VL - 5

SP - 79

EP - 87

JO - Prehospital Emergency Care

JF - Prehospital Emergency Care

SN - 1090-3127

IS - 1

ER -