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Commence, continue, withhold or terminate?: a systematic review of decision-making in out-of-hospital cardiac arrest

Anderson, Natalie E.; Gott, Merryn; Slark, Julia

European Journal of Emergency Medicine: April 2017 - Volume 24 - Issue 2 - p 80–86
doi: 10.1097/MEJ.0000000000000407

When faced with an out-of-hospital cardiac arrest patient, prehospital and emergency resuscitation providers have to decide when to commence, continue, withhold or terminate resuscitation efforts. Such decisions may be made difficult by incomplete information, clinical, resourcing or scene challenges and ethical dilemmas. This systematic integrative review identifies all research papers examining resuscitation providers’ perspectives on resuscitation decision-making for out-of-hospital cardiac arrest patients. A total of 14 studies fulfilled the inclusion criteria: nine quantitative, four qualitative and one mixed-methods design. Five themes were identified, describing factors informing resuscitation provider decision-making: the arrest event; patient characteristics; the resuscitation scene; resuscitation provider perspectives; and medicolegal concerns. Established prognostic factors are generally considered important, but there is a lack of resuscitation provider consensus on other factors, indicating that decision-making is influenced by the perspective of resuscitation providers themselves. Resuscitation decision-making research typically draws conclusions from evaluation of cardiac arrest registry data or clinical notes, but these may not capture all salient factors. Future research should explore resuscitation provider perspectives to better understand these important decisions and the clinical, ethical, emotional and cognitive demands placed on resuscitation providers.

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aAuckland Emergency Department, Auckland City Hospital

bSchool of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

Correspondence to Natalie E. Anderson, MSc, School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, Auckland, New Zealand Tel: +64 9 923 7874; fax: +64 9 367 7158; e-mail:

Received September 20, 2015

Accepted April 15, 2016

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