To resuscitate or not (bus stop spin off)

[Bieber]

Aren't those two statements contradictory?

Not necessarily, although in the future we will probably withhold resuscitative efforts for patients who present in an initial rhythm of asystole. For now, though, asystole isn't recommended by the AHA as an indication for the withholding of resuscitative efforts in se. In contrast, if we know that the patient's downtime has been at least thirty minutes, then there's obviously no chance of a meaningful survival (with rare exception) versus someone who presents in asystole who may have only been down for a few minutes.

[Arctickat]

There is a special circumstance that no one else has mentioned in this.

Organ donors.

http://ejcts.oxfordj.../5/929.abstract

http://www.parl.gc.c...s/prb0824-e.htm

In a July 2005 report, the Canadian Council for Donation and Transplantation (CCDT) recommended considering as organ donor candidates people who have succumbed to cardiac death, also known as cardiorespiratory death (DCD). Circumstances that could result in DCD include cardiac arrest in someone already brain-dead; unsuccessful resuscitation of a person in cardiac arrest; and cardiac arrest following withdrawal of treatment in the intensive care unit. The latter is referred to as “controlled” DCD because preparations for organ removal and preservation can be initiated before the donor’s death, thereby controlling the timing of the withdrawal of treatment. (22) Information from CIHI indicates that DCD began in 2006, but only in Ontario and Quebec.

Given this information, would you consider resuscitation as a means to ensure that the organs can remain viable until they can be harvested; knowing full well that the potential for an actual long term ROSC could result in a patient who would require institutional care 24/7 for years to come?

Edit:

Just to note, I have, in fact, done CPR for three or more hours to transport an organ donor for harvesting.

Edited May 14, 2012 by Arctickat

[paramedicmike]

It depends on local organ harvesting practices. A patient who has experienced cardiac arrest and been resuscitated may not be a candidate for harvesting simply due to the fact that they coded.

[Bieber]

I'm uneasy about the idea of running someone for the sole purpose of harvesting their organs, though I admit I can't find a rational justification for that uneasiness.

[craig]

Aren't those two statements contradictory?

And this is funny as hell right here...

"...Competent patients have the right to decline ... resuscitation in the event of cardiac arrest..."

I thought that as well dwayne......never met a patient in cardiac arrest that was competent enough to sign or verbalise any type of consent.....but we may do things different down under..........

[Arctickat]

It depends on local organ harvesting practices. A patient who has experienced cardiac arrest and been resuscitated may not be a candidate for harvesting simply due to the fact that they coded.

Why would that disqualify them? It's quite common.

[paramedicmike]

Because during a cardiac arrest perfusion stops. The potential for end organ damage due to lack of perfusion during that period of arrest adversely affects the viability of the organs in question.

Some places may have greater allowances for organs post arrest. But it does raise a lot of questions and can increase the potential for failure/rejection.

[Richard B the EMT]

When my dad died, I have no idea how long the ambulance and ER crew had been working him up, prior to my Captain driving me to the ER to meet up with my mom. Resuscitative efforts had already been terminated. I was talking about organ donation with her, when the on-duty transplant coordinating nurse walked up to us, and joined our conversation.

While my dad was a diabetic cardiac, the "harvesting" team that later worked my dad's remains, at the Queens County Medical Examiner's office, got skin for burn victims, and 4 people got partial corneal transplants. I don't recall if they tried for the kidneys.

[Kiwiology]

Anyway, I was very impressed with the KCM1 Compelling Reasons Approach... comments?

I like it!

And this is funny as hell right here...

"...Competent patients have the right to decline ... resuscitation in the event of cardiac arrest..."

What that means is that a competent patient has the right to describe an advance directive declining resuscitation from cardiac arrest (including a verbal directive); all patients are competent until proven otherwise and such a directive must be honoured.

Interesting to see some saying somebody who is in asystole when the crew turn up and people who are dying from severe systemic disease should be resuscitated. If they have a clearly described directive that they want resuscitating then sure, it's what they want, but in the absence of such a directive it's either clinically futile or not in the patients best interest. I don't think we should be putting the patient and family through the brutality and false hope of trying to resuscitate somebody who is not coming back or if they do get a pulse is just going to languish in ICU for a day or so then die anyway.

[Bieber]

The point you make about the vegetability (new word, enjoy) of asystolic code saves is a good one, Kiwi. And you're right, we probably shouldn't be bothering with them; and I don't expect we will for much longer. I've rethought my position on that one and I'll retract it; as far as the issue of persons with terminal illnesses, I'll have to think about that one for a while longer--although I think at that point we're getting into some especially murky ethical waters.