How do prehospital physicians decide when to start/stop CPR?

Prehospital physicians routinely make the decision to start (or continue) or withhold (or terminate) cardiopulmonary resuscitation (CPR) based on situational and immediately available factors, such as patient age and resuscitation efforts by the emergency team, a recent study has found.

Researchers retrospectively reviewed anonymized data from 1,525 patients (median age, 74 years; 935 men) who had an out-of-hospital cardiac arrest (OHCA). Pertinent patient-related, process-related, and supplemental factors, such as age and sex, physician response time, and comorbidities, were retrieved. CPR was considered withheld if efforts were not started or terminated within 3 minutes from arrival.

Most (66 percent) of the OHCA cases were encountered at home, while only 7 percent were encountered by emergency personnel directly. In 39 percent of cases, bystander CPR was administered. Resuscitation efforts were already ongoing in 81 percent (n=1,004) of the patients.

In majority of cases (74 percent; n=920), prehospital care physicians attempted or continued CPR efforts; in the remaining 26 percent (n=327), resuscitation was either withheld or stopped.

Multivariate logistic regression analysis revealed that if a patient was already receiving resuscitation efforts by emergency personnel, CPR was >60 times more likely to be sustained by the prehospital physician (odds ratio [OR], 60.45, 95 percent confidence interval [CI], 19.89–184.29).

The patient’s first-monitored heart rhythm compared to asystole was also a strong predictor of CPR initiation or continuation: pulseless electrical activity (OR, 3.07, 95 percent CI, 1.21–7.79) and ventricular fibrillation or pulseless ventricular tachycardia (OR, 29.25, 95 percent CI, 1.93–442.51).

On the other hand, negative predictors included known malignancies (OR, 0.22, 95 percent CI, 0.05–0.92) and the physician unit’s response time (OR per minute, 0.92, 95 percent CI, 0.87–0.97).