Focus Topic: Decision-Making Regarding Resuscitation from Cardiac Arrest in the ICU

Cardiopulmonary resuscitation (CPR) in intensive care units (ICUs) differs in several ways from treatment of a cardiac arrest occurring outside the hospital or in other areas of the hospital, not only in the availability of advanced invasive treatment options (such as extracorporeal life support) but also in pre-existing conditions and severity of illness which may make prognostication more difficult. In addition, patients in the ICU are often receiving substantial levels of life-supporting therapies when arrest occurs, and thus CPR may have minimal prospects of success. Application of the ethical principles beneficence, maleficence, autonomy, and (distributive) justice as well as careful consideration of the treatment pillars “medical indication” and “patient’s consent” is therefore a special challenge, especially in relation to withholding or terminating resuscitative attempts. Following these principles, this chapter spotlights the topics “slow codes,” “do not attempt resuscitation” orders, and the special challenges of extracorporeal CPR.