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Cardiorespiratory arrest: resuscitate as quickly as possible without unreasonable obstinacy

In the event of cardiorespiratory arrest, the rapid application of resuscitation procedures determines the chances of survival without neurological after-effects.

In the event of cardiorespiratory arrest, a mobile resuscitation team must be called, and then, if possible life-saving procedures should be applied: unblocking the airways, artificial respiration via mouth-to-mouth or mouth-to-nose, and external cardiac massage.

Prescrire reports on the available assessments of delay after which resuscitating a victim of sudden cardiorespiratory arrest outside a hospital is futile.

Treatment of cardiorespiratory arrest victims aims to save their lives without neurological after-effects (resulting from the brain being starved of oxygen for too long). Doctors must evaluate the patient’s chances of survival as best they can before beginning or continuing resuscitation without unreasonable obstinacy.

The chances of survival with no neurological after-effects appear to be nil if emergency services doe not arrive within 8 minutes and the electrocardiogram is flat on the arrival of a specialist team. If spontaneous circulatory activity does not re-start after 30 minutes of resuscitation, the chances of survival are considered to be virtually nil. However, medicalised resuscitation is sometimes continued for more than 30 minutes in some exceptional circumstances (hypothermia, drug intoxication, etc.) or to reassure the person’s entourage that everything possible has been tried.

 ©Prescrire 1 October 2010

 "Cardiac arrest in the out-of-hospital setting: when to halt resuscitation" Prescrire Int 2010 ; 19 (109) : 228-229. (Pdf, subscribers only)

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