When is it futile for ambulance personnel to initiate cardiopulmonary resuscitation?

Objective: To determine whether patients with unexpected prehospital cardiac arrest could be identified in whom ambulance resuscitation attempts would be futile.

Design: Review of ambulance and hospital records; detailed review of automated external defibrillator rhythm strips of patients in whom no shock was advised.

Setting: Scottish Ambulance Service; all cardiopulmonary resuscitation attempts after cardiorespiratory arrest during 1988-94 included in the Heartstart Scotland database.

Subject: 414 cardiorespiratory arrest patients with no pulse or breathing on arrival of ambulance personnel, no bystander cardiopulmonary resuscitation performed, and more than 15 minutes from time of arrest to arrival of ambulance. Patients were stratified into those with "shockable" and "non-shockable" rhythms.

Main Outcome Measures: Return of spontaneous circulation, or survival to reach hospital alive, or survival to discharge, or all three.

Results: No patient with a non-shockable rhythm who met the entry criteria for analysis survived a resuscitation attempt. Review of the defibrillator rhythm strips of these patients failed to find any case in which the tracing was deemed compatible with survival.

Conclusion: On the basis that it would be inappropriate to initiate vigorous resuscitation in patients who can be identified as "dead" and beyond help an algorithm was prepared to guide ambulance personnel.