Presumed futility in paramedic-treated out-of-hospital cardiac arrest: an Utstein style analysis in Tampere, Finland

Abstract

Aim: To report prospectively the outcome from prehospital cardiac arrest according to the Utstein template in the city of Tampere, Finland, with special reference to those patients in whom resuscitation was not attempted.

Materials and methods: In Tampere (population 203,000), a two-tiered emergency medical service (EMS) system provides first response and basic life support (BLS), supported by advanced life support (ALS) units staffed with nurse-paramedics. We analysed all out-of-hospital cardiac arrests considered for resuscitation during a 12-month period.

Results: Of 191 patients with prehospital cardiac arrest, resuscitation was not attempted in 98 patients (51%). Reasons to withhold from resuscitation were estimated futility (97 cases) and a do-not-attempt-resuscitation order (1). Sixty percent of the patients with no resuscitation had secondary signs of death, 97% had asystole as the initial cardiac rhythm and 98% had suffered an unwitnessed cardiac arrest. Resuscitation was successful in 45 of the remaining 93 patients with attempted resuscitation. Twelve patients were discharged (overall survival rate 13%), nine of them with a CPC score of 1 or 2. Fifteen patients were treated with therapeutic hypothermia. Of the bystander-witnessed cardiac arrests with VF as initial rhythm, 29% survived.

Conclusions: The Tampere EMS system initiated resuscitation less frequently than reported from other EMS systems, but the reasons to withhold resuscitation seemed justified. The overall and Utstein's 'golden standard' survival rates were comparable with previous reports.