Decisions about withholding or withdrawing resuscitation are fraught with ethical and moral dilemmas. This is particularly apparent when the death is sudden and unexpected, as is the case in cardiac arrest due to trauma.
Ambulance services, and the medical committees advising these organizations on clinical practice standards, have attempted to support the decision making process through the development of clinical practice guidelines or protocols. Such documents tend to provide explicit advice about withholding interventions in cases where death is clearly obvious, even to the lay public. However the paramedic will encounter cases of traumatic cardiac arrest where these guidelines do not provide definitive answers about the management of the case.
One could argue that in these cases it is better to resuscitate and allow medical officers to make decisions about the continuation of resuscitation. There are however some risks associated with this approach, which includes an increased risk of accidents when managing and transporting cases that are deemed to be time-critical.
Decisions relating to any clinical intervention should be defensible, based on sound reasoning, and informed by best evidence. As such, ambulance services need to ensure resuscitation algorithms take account of research that identifies clinical predictors of resuscitation success or failure. Paramedics should be able to use this evidence to confidently decide when resuscitation is futile.
This presentation examines current evidence relating to the resuscitation of traumatic cardiac arrest, and makes recommendations regarding the strengths and weaknesses of existing protocols that are designed to aid clinical decisions and actions in such cases.
BHlthSc, GDipCBL, MEd.
Bill was employed by the Ambulance Service of New South Wales as an intensive care paramedic and paramedic educator before moving to Charles Sturt University in 1996, where he was a senior lecturer and coordinator of the Bachelor of Clinical Practice (Paramedic) course. In 2004 he was appointed to the position of Head, Undergraduate Paramedic Programs at Monash University in Melbourne.
Bill's research interests include clinical decision making and diagnostic reasoning, evidence-based practice, and pain management in the prehospital setting. He is currently undertaking a PhD, which involves a study of paramedic pain management. In his spare time Bill continues to practice as a paramedic with the Metropolitan Ambulance Service in Melbourne.
“To resuscitate or not: does the research evidence provide any answers in cases of traumatic cardiac arrest?”.
Australasian Journal of Paramedicine, 1(3).
Retrieved from http://ro.ecu.edu.au/jephc/vol1/iss3/33