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June 2016

Resuscitations That Never End: Originating From Unresolved Integrity-Related Moral Distress

Author Affiliations
  • 1Department of Pediatric Critical Care Medicine, Baylor College of Medicine/Texas Children’s Hospital, Houston
  • 2Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
JAMA Pediatr. 2016;170(6):521-522. doi:10.1001/jamapediatrics.2016.0030

Cardiopulmonary resuscitation (CPR) is a time-dependent clinical intervention. Unlike most other clinical interventions (eg, antibiotics for sepsis, chemotherapy regimens, and duration of mechanical ventilation) that are marked with distinct start and stop times, attempts at CPR are dependent on many process times requiring intense multidisciplinary teamwork in a short period of time. Process times that are simultaneously coordinated and recorded include the following: when the nurses and physicians arrive in the patient’s room; the administration of medication; the cycle of chest compressions; pulse and rhythm checks; defibrillations or cardioversion attempts; and the last recorded time in a resuscitation, return of spontaneous circulation, or death. The resuscitation team leader declares, “the end,” and the team’s work stops. The title of this Viewpoint therefore appears paradoxical: how can it be that cardiopulmonary resuscitation never ends?

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