Ending a resuscitation

This case comes to us from Dr. Mark McKinney.

Mark is an EM resident at the University of Ottawa who completed a fellowship in Simulation through The University of Ottawa Skills and Simulation Centre.

His academic interests are in education, simulation, and translational simulation; including where simulation can improve hospital and emergency department preparedness.


Unlike many other death cases, this case is intentionally “simple” and representative of out-of-hospital cardiac arrest, allowing greater focus on death as the primary educational goal. The case and debrief can explore important topics such as recognition of futility in resuscitation, having the participant commit to and own a decision for termination, and explore the impacts related with that decision. Impacts may include discussion on the emotional impacts of death, physician wellness, and the physician role in terminating resuscitation. For senior learners, scaffolding breaking bad news or a hot debrief with their team can take the topic even further.


Out of hospital cardiac arrest. EMS called for chest pain. Patient collapsed on EMS arrival, witnessed arrest, CPR started. Total transport time 30 minutes. Shock x1 for ventricular fibrillation. Now in asystole.


The medical aspect of this case is a relatively straight-forward out-of-hospital cardiac arrest where the team must recognize futility and make the decision to stop resuscitation efforts. The primary goal is simulating the experience of making a termination of resuscitation decision, and managing the impacts of a patient’s death. Other goals could also be scaffolded onto this scenario as deemed appropriate by the simulation instructor, including breaking bad news to family member or a simulated hot debrief with the team. 


Image Courtesy of https://emcow.files.wordpress.com/2012/11/normal-intubation2.jpg

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