Abstract 187: Ethics of Codes: Provider Perspectives on Cardiopulmonary Resuscitation Duration
Background: Code success can be influenced by many factors such as location of arrest, length of code, patient comorbidities, but also bias. Current recommendations for code duration range from ten to thirty minutes. Recent data suggests that longer resuscitation efforts may result in favorable outcomes. We sought to examine provider attitudes toward code duration and appropriateness.
Methods: Email invitations were sent to residents in internal medicine and emergency medicine, nurses, midlevel providers, rapid response team members, and attending physicians in emergency medicine and cardiology at a single academic institution. The survey evaluated experience with codes as well as knowledge of recommendations and literature concerning code duration and outcomes. Email invitations were sent to 605 providers in 2 waves; 162 (26.8%) completed the survey.
Results: Of respondents, 82 (51%) were female. A majority (n=59, 36%) were age 26-30 and were Caucasian (n=117, 75%). The sample included 47 (29%) attendings, 44 (28%) residents, 37 (23%) nurses, 19 (12%) fellows, 11 (7%) interns, and 2 (1%) physician assistants/nurse practitioners. Only 34% of respondents indicated they were familiar or very familiar with literature on code duration and outcomes (range: 56% of attendings, 21% of residents). A substantial minority, 32%, believed a “slow code” to be appropriate or very appropriate, when the team believes resuscitation is futile and the patient/family disagrees, including 35% of nurses and 50% of interns, 28% of women and 34% of men. On the 5 point scale, respondents rated the importance of each of the following factors in deciding when to stop CPR: code duration (average score=4.11), patient comorbidities (3.95), patient’s age (3.68), initial rhythm (3.55), end tidal CO2 measurement (2.94), and location of arrest (2.75). Every respondent over age 50 (100%) agreed or strongly agreed that comorbid conditions were important when deciding to end a code vs. 70% under age 50 (p=0.003).
Conclusions: This preliminary study suggests that a variety of factors may influence decisions about code termination which may not be in line with emerging evidence. A substantial minority of respondents considered slow codes to be appropriate in the setting of futility. Future research is needed to determine the knowledge base and decision-making processes of providers who participate in decisions about CPR duration.
Author Disclosures: T.J. Young: None. S. Perman: None. M. Daeschler: None. D. Kolansky: None. D. Gaieski: None. J.N. Kirkpatrick: None.
- © 2014 by American Heart Association, Inc.