The cardiopulmonary resuscitation-not-indicated order: futility revisited
Article Abstract:
Cardiopulmonary resuscitation (CPR)-not-indicated orders should be based on the concept of physiologic futility. Physicians may write CPR-not-indicated orders for patients in whom CPR would be futile. Futility may be based on the inability of a treatment to achieve its physiologic goal (physiologic futility), a very low likelihood of patient survival (quantitative futility), or an extremely poor quality of life after resuscitation (qualitative futility). Sample CPR-not-indicated policies in four hospitals reflect the varying criteria used to define qualitative and quantitative futility. These futility measures are often colored by physicians' or communities' value judgements. The physiologic criteria for futility is objective. Because it limits the need for qualitative and quantitative judgements, physicians are less likely to impose their values on their patients.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1995
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Clinical, hemodynamic, and cardiopulmonary exercise test determinants of survival in patients referred for evaluation of heart failure
Article Abstract:
Exercise capacity as measured by peak ventilatory oxygen uptake (VO2) during exercise appears to be an accurate predictor of outcome in patients with congestive heart failure. Researchers analyzed many different physiological characteristics in 644 patients with heart failure. Peak VO2 was the most important characteristic in predicting which patients would do well. Research has shown that patients with VO2 less than 10 milliliters per kilogram per minute have a poor prognosis, but those with VO2 greater than 14 have a prognosis similar to those who receive a heart transplant.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1998
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The next chapter in the high-dose epinephrine story: unfavorable neurologic outcomes?
Article Abstract:
Emergency medical personnel may need to reconsider using high-dose epinephrine during cardiopulmonary resuscitation in patients in cardiac arrest. Many emergency physicians start with a 1 milligram dose and then increase the dose every few minutes. They believe that the brain can only be saved by restoring a regular heartbeat. Epinephrine can improve blood flow to the heart and brain. However, a 1998 study found that patients who recover from cardiac arrest and received high-dose epinephrine were more likely to have an unfavorable neurologic outcome.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1998
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