key: cord-0737829-p5lmt0nc
authors: Sulzgruber, Patrick; Schnaubelt, Sebastian; Krammel, Mario
title: Ethical Considerations during Critical Care from an Age-Specific Perspective
date: 2021-08-04
journal: Resuscitation
DOI: 10.1016/j.resuscitation.2021.06.029
sha: 0bf5a6c4ec8e7c209f798e466d7493c140a48e1a
doc_id: 737829
cord_uid: p5lmt0nc

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Additionally, the afore mentioned guidelines say that resuscitative attempts, as in a medical intervention with low likelihood of success, should not be performed in futile cases -but assessing futility in a precise, prospective and applicable way remains difficult during cardiac arrest.

Futile resuscitation warrants further discussion. The term "medical futility" mirrors an approach regarding a specific intervention as "futile" if it has been unsuccessful within the past 100 cases or a treatment merely preserves permanent unconsciousness or cannot end dependence on intensive medical care.(3) Therefore, a chance of less than 1% of success of medical therapy or intervention should be assumed as "medically futile". Recent data indicated that patients older than 85 years experiencing cardiac arrest had a poor 30-day survival rate of approximately 5% reaching favorable neurological outcome in less than 1% of all cases. Considering the results of recent analysis, this threshold of ≥1% was not reached for favorable neurological outcome in old and frail individuals within recent reports. (4) A number of well powered reports highlighted that especially older individuals are less afraid of death itself but fear the loss of their physical and mental autonomy including living in a vegetative neurological state. (5) (6) Taking this data into account, it is essential not to focus solely on survival but also on measures for a favorable neurological outcome after cardiac arrest, which proved to be of utmost importance in older individuals.

In this regard the patients' autonomy as well the principle of beneficence needs to be taken into account. While withholding life-supporting therapies in individuals with futile prognosis is indisputable, healthcare providers need to consider the patients' wish for the capability of physical and mental autonomy after survival of cardiac arrest when facing this ethical dilemma in deciding whether for or against the initiation of resuscitative efforts in older individuals during but also after COVID-19.

Do not attempt cardiopulmonary resuscitation (DNACPR) decisions in people admitted with suspected COVID-19: Secondary analysis of the PRIEST observational cohort study

European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions

Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial

Age-specific prognostication after out-ofhospital cardiac arrest -The ethical dilemma between 'life-sustaining treatment' and 'the right to die' in the elderly. Eur Heart J Acute Cardiovasc Care

End-of-life decision making: a qualitative study of elderly individuals

Conflict of interest Statement for the Manuscript entitled "Ethical Considerations during Critical Care from an Age-Specific Perspective

None

Not applicable

None of the authors has a potential conflict of interest with regard to the content of the manuscript.

No funding for the conduction of the present investigation was received.

Both authors contributed equally in this work.

None of authors have any financial and personal relationships with other people or organizations that could inappropriately influence their work.

The study sponsors had no influence on the study design, on the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. 7.