- Email: [email protected]
Life signs in “dead” patients
Resuscitation 83 (2012) e164
Contents lists available at SciVerse ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Life signs in “dead” patients Sir,
Conflict of interest None.
Interruption of resuscitation has major ethical issues.1 We recently faced an ethical dilemma, while managing two patients with cardiac arrest. Patients were managed by an Emergency Physician in prehospital setting.2 No recuperation of cardiac activity occurred despite prolonged advanced life support. The continuation of resuscitation process appeared trivial. Nevertheless, during automated chest compressions, the first patient (57-year-old) opened or closed his eyes and moved his arms when asked by the Physician. However, resuscitation was stopped. The second patient (58-year-old) presented spontaneous movements from both arms during automated chest compressions. Sedation was given. He was transported to an hospital to perform extra-corporeal life support (ECLS). He died on day-1. The presence of life signs in “dead” patients was a deeply disturbing event. Such situation is not mentioned in guidelines.3 Before ECLS development, no solution was available. Physician had to stop resuscitation despite the disturbing presence of life signs. ECLS is a relevant alternative.4 Such situation should be considered in future guidelines and studies. Life signs should be clearly defined. Management guidelines, including ECLS, should be proposed.
References 1. Shaner DM. Up in the air-suspending ethical medical practice. N Engl J Med 2010;363:1988–9. 2. Adnet F, Lapostolle F. International EMS systems: France. Resuscitation 2004;63:7–9. 3. Morrison LJ, Kierzek G, Diekema DS, et al. Part 3: ethics: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl. 3):S665–75. 4. Agostinucci JM, Ruscev M, Galinski M, et al. Out-of-hospital use of an automated chest compression device: facilitating access to extracorporeal life support or nonheart-beating organ procurement. Am J Emerg Med 2011;29:1169–72.
Lapostolle Frédéric ∗ Petrovic Tomislav Alhéritière Armelle Agostinucci Jean-Marc Adnet Frédéric SAMU 93, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France ∗ Corresponding
author. Tel.: +33 1 48 96 44 54/55/56; fax: +33 1 48 96 44 45. E-mail address: [email protected] (L. Frédéric)
Disclosure 27 August 2011 None.
0300-9572/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2012.01.045
Contents lists available at SciVerse ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Life signs in “dead” patients Sir,
Conflict of interest None.
Interruption of resuscitation has major ethical issues.1 We recently faced an ethical dilemma, while managing two patients with cardiac arrest. Patients were managed by an Emergency Physician in prehospital setting.2 No recuperation of cardiac activity occurred despite prolonged advanced life support. The continuation of resuscitation process appeared trivial. Nevertheless, during automated chest compressions, the first patient (57-year-old) opened or closed his eyes and moved his arms when asked by the Physician. However, resuscitation was stopped. The second patient (58-year-old) presented spontaneous movements from both arms during automated chest compressions. Sedation was given. He was transported to an hospital to perform extra-corporeal life support (ECLS). He died on day-1. The presence of life signs in “dead” patients was a deeply disturbing event. Such situation is not mentioned in guidelines.3 Before ECLS development, no solution was available. Physician had to stop resuscitation despite the disturbing presence of life signs. ECLS is a relevant alternative.4 Such situation should be considered in future guidelines and studies. Life signs should be clearly defined. Management guidelines, including ECLS, should be proposed.
References 1. Shaner DM. Up in the air-suspending ethical medical practice. N Engl J Med 2010;363:1988–9. 2. Adnet F, Lapostolle F. International EMS systems: France. Resuscitation 2004;63:7–9. 3. Morrison LJ, Kierzek G, Diekema DS, et al. Part 3: ethics: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl. 3):S665–75. 4. Agostinucci JM, Ruscev M, Galinski M, et al. Out-of-hospital use of an automated chest compression device: facilitating access to extracorporeal life support or nonheart-beating organ procurement. Am J Emerg Med 2011;29:1169–72.
Lapostolle Frédéric ∗ Petrovic Tomislav Alhéritière Armelle Agostinucci Jean-Marc Adnet Frédéric SAMU 93, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France ∗ Corresponding
author. Tel.: +33 1 48 96 44 54/55/56; fax: +33 1 48 96 44 45. E-mail address: [email protected] (L. Frédéric)
Disclosure 27 August 2011 None.
0300-9572/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2012.01.045