In-Hospital Resuscitation Following Unsuccessful Prehospital Advanced Cardiac Life Support - Heroic Efforts or an Exercise in Futility?

Sep 23, 2026

Uploaded by Terk

Emergency department logbook data analyzed 281 consecutive patients transported after failed prehospital advanced cardiac life support for out-of-hospital cardiac arrest. Medical records were available for 240 cases. Initial rhythms included ventricular fibrillation/pulseless ventricular tachycardia (29%), electromechanical dissociation (18%), and asystole (51%). Only 32 patients were successfully resuscitated in the ED, with four surviving to discharge. Two survivors had good neurologic outcomes before rapid deterioration. Authors conclude failure to respond to prehospital ACLS predicts non-survival and may support stopping field efforts, emphasizing optimized prehospital care before irreversible deterioration.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Methods

Study setting

Prehospital and ED resuscitation guidelines

Data collection and outcome definitions

Results

ORIGINAL CONTRIBUTION emergency medical services,cardiac arrest,in-hospital resuscitation;resuscitation,cardiac arrest # In-Hospital Resuscitation FollowingUnsuccessful Prehospital AdvancedCardiac Life Support:'Heroic Efforts'Or an Exercise in Futility? From our emergency department logbook we identified 281 consecutive pa-tients transported to the Regional Medical Center at Memphis followingfailed prehospital advanced cardiac life support (ACLS).Medical recordswere obtained for 240 cases (85.4%).Initial cardiac rhythms in the ED in-cluded ventricular fibrillation or pulseless ventricular tachycardia(29%),electromechanical dissociation(18%),and asystole (51%).Thirty-two pa-tients (13.3%)were successfully resuscitated in the ED,but only four(1.7%)survived to hospital discharge.Two patients had good neurologic outcomes;both degenerated to cardiac arrest shortly prior to arrival in the ED.Theremaining two survivors were discharged to nursing homes with severe neu-rologic deficits.Of the 41 cases for whom no medical records could befound,39 were noted in our logbook to have died in the ED.No record ofsubsequent hospital admission could be found for the other two.Both arepresumed to have died.Failure to respond to prehospital ACLS predicts non-survival and may warrant cessation of efforts in the field.Future programsand research efforts in the management of out-of-hospital cardiac arrestshould be focused on optimal provision of prehospital care prior to the onsetof irreversible deterioration.[Kellermann AL,Staves DR,Hackman BB:In-hospital resuscitation following unsuccessful prehospital advanced cardiaclife support:'Heroic efforts'or an exercise in futility?Ann Emerg Med June1988;17:589-594.] Arthur L Kellermann,MD,MPHDiane R Staves,MDBela B Hackman,MDMemphis,Tennessee From the Departments of Medicineand Community Medicine,Universityof Tennessee,Memphis,Tennessee. Received for publication August 20,1987.Revision received January 18,1988.Accepted for publication February 10,1988. Presented at the Society for GeneralInternal Medicine National Meeting inSan Diego,California,April 1987. Address for reprints:Arthur Kellermann,MD,MPH,Division of EmergencyMedicine,Department of Medicine,877Jefferson,Room G071,Memphis,Tennessee 38103. ## INTRODUCTION Despite two decades of dramatic advances in emergency cardiac care,amajority of victims of out-of-hospital cardiac arrest fail to respond to pre-hospital efforts at resuscitation.1-3 In many metropolitan areas,paramedicsemergently transport patients who fail to respond to prehospital advancedcardiac life support (ACLS)to the nearest hospital for continued efforts atresuscitation. A decision to transport a patient in refractory cardiac arrest commits aparamedic crew to hazardous high-speed driving.The emergency departmentmust rapidly mobilize available personnel to continue the attempt of resusci-tation.Any patient successfully resuscitated then is admitted to an intensivecare unit,often for a stormy hospital course. Reports have failed to focus on this important subgroup of patients.Infor-mation regarding the clinical outcomes of these patients has been scant.Nostudies have directly examined the personnel and monetary costs associatedwith decisions to continue resuscitation efforts despite unsuccessful pre-hospital ACLS.Our study was conducted to examine these issues. ## METHODS The Regional Medical Center at Memphis is a 435-bed,adult,acute carehospital supported,in part,by the government of Shelby County,Tennessee.The hospital and its ED are staffed by residents and faculty of the Universityof Tennessee,Memphis.The ED at the Regional Medical Center averages 65,000 visits annually and is the point of entry for three-quarters of all non-obstetric admissions. Emergency medical services (EMS)for the City of Memphis are providedby the Memphis Fire Department(MFD)EMS Bureau.The Bureau operates14 ambulances staffed by two paramedics each,who are authorized to pro- 17:

FAQs

What patient group was studied and how were they identified?

The study analyzed 281 consecutive patients transported to the Memphis Regional Medical Center after unsuccessful prehospital advanced cardiac life support. The authors reviewed emergency department records from their emergency department logbook and obtained medical records for 240 cases.

What were the main initial cardiac rhythm categories in the emergency department?

Initial ED rhythms were ventricular fibrillation or pulseless ventricular tachycardia (29%), electromechanical dissociation (18%), and asystole (51%).

How often did patients survive to hospital discharge after ED resuscitation?

Thirty-two patients (13.3%) were successfully resuscitated in the ED, but only four (1.7%) survived to hospital discharge, indicating poor overall survival despite continued efforts.

Sep 23, 2026

Uploaded by Terk