Successful Emergency Medical Resuscitation: Are Continued Efforts in the Emergency Department Justified?

Gray WA, Capone RJ, Most AS New England Journal of Medicine 1991 Vol 325 Pages 1393-1398

The authors evaluated the efficacy and costs of continued hospital resuscitation for patients in whom resuscitation efforts outside the hospital had failed. The records of 185 patients with on-going resuscitation presenting at the Rhode Island Hospital Emergency Department between October 1, 1985 and June 30, 1987, were reviewed. Patients were excluded from the study if their arrests were due to trauma or drowning or if they were under 16 years old. The mean age was 67 +/- 15 years. Patients who died of other than cardiac causes (16/185 or 9%) tended to be younger (mean age, 47 +/- 21 years vs. 68 +/- 13 years, P<0.01) and most had respiratory arrests. One hundred and twenty-three patients (66%) were male, and 148 (80%) were white. Over the 19-month period, only 16 of the 185 patients (9%) were successfully resuscitated in the Emergency Department and admitted to the hospital. A shorter duration of prehospital resuscitation was the only characteristic of the resuscitation associated with an improved outcome in the Emergency Department. No patient survived until hospital discharge, and all but one were comatose throughout hospitalization. The mean stay in hospital was 12.6 days (range 1-11) in an ICU. The total hospital cost (not including professional fees) for the 16 patients admitted was $180,908 in 1991 U.S. dollars (range per patient $1,984 to $95,144). The authors conclude that in general, continued resuscitation efforts in the emergency department for victims of cardiopulmonary arrest in whom prehospital resuscitation has failed are not worthwhile, and they consume precious institutional and economic resources without gain. Given the uniformly fatal outcome, it is difficult to justify the use of the facilities and personnel required for this care. In a broader context, emphasis should be placed on prehospital care for the patient with cardiopulmonary arrest, since it is clear that patients treated in this setting have the greatest chance of successful resuscitation.