Decision making by emergency physicians when assessing cardiac arrest patients on arrival at hospital

Objective: To investigate the factors which influence decision making by experienced emergency physicians when they decide whether to (a) pronounce ‘life extinct’ in adult patients with non traumatic cardiac arrest while in the ambulance, or (b) bring them into the resuscitation room in the Emergency Department for further assessment/management. Design: Qualitative study involving semi structured interviews and a focus group. Setting: Accident & Emergency (A&E) departments in the Yorkshire region. Participants: Fifteen emergency physicians (two clinical fellows, nine specialist registrars and four consultants) working in the Yorkshire region. Results: Six main themes were identified that impacted upon the decision making process: the doctor's past experience, ambulance service issues, prehospital care, patient characteristics, presence and views of relatives, and organisational issues. Conclusion: The reasoning behind decisions made when a patient arrives at the Emergency Department in cardiac arrest is multifactorial. Strict guidelines would be difficult to construct since individuals vary in the importance they attach to different factors. Objectivo: Investigar os factores que influenciam a tomada de decisão por médicos da emergência experientes quanto à decisão de a) declarar a morte em adultos vı́timas de paragem cárdio respiratória não traumática, b) iniciar a reanimação no departamento de urgência com a intenção de fazer a avaliação / tratamento ulterior. Desenho: estudo qualitativo envolvendo entrevista semi estruturada e em “focus group”. Contexto: departamento de “Accident & Emergency” (A&D) na região de Yorkshire. Participantes: quinze Médicos de Emergência (dois clı́nicos gerais, nove especialistas e quatro consultores) a trabalhar na região de Yorkshire. Resultados: Identificaram-se seis temas principais com influência no processo de tomada de decisão.