By Will Boggs, MD

NEW YORK, Mar 28 (Reuters Health) - Three simple criteria can be used to determine whether resuscitation efforts such as CPR after a person's heart has stopped beating will have a reasonable chance of success, researchers report.

"Decision making about resuscitation is difficult for both patients and physicians. For the latter, deciding when to stop resuscitative efforts is especially tough," Dr. Carl van Walraven, from the University of Ottawa in Ontario, Canada, told Reuters Health.

The research team has identified three simple factors that distinguished patients eventually discharged from the hospital after a cardiac arrest from those who died in the hospital. Patients who survived experienced a cardiac arrest that was witnessed by someone else, had a particular type of heart rhythm (either ventricular tachycardia or ventricular fibrillation) after their cardiac arrest, or had their pulse return within the first 10 minutes of cardiopulmonary resuscitation (CPR).

In their report in the March 28th issue of The Journal of the American Medical Association, the authors describe the results of applying this "decision aid" in a large community hospital.

According to the report, the decision aid accurately identified 99.1% of the patients who were ultimately discharged alive from the hospital after their cardiac arrest.

The decision factors were incorrect only three times out of more than 2,000 resuscitation efforts, the report indicates. One of these patients was transferred to another hospital and died 2 months later, while the other two patients were discharged to nursing homes because they required skilled care.

"This simple decision aid will hopefully help physicians identify, early in the resuscitation, patients who have a chance of getting out of the hospital and (those) for whom the chances are very low," van Walraven concluded.

Patients might also use this information to specify how they wish to be treated if their heart stops beating. "This decision aid could allow patients to be more directive in their end-of-life decision making," van Walraven said. "They might direct physicians to attempt resuscitation but cease efforts if they do not satisfy the decision aid at 10 minutes into the resuscitation. However, patients should know that the aid applies only to in-hospital resuscitations."

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