Termination of resuscitative efforts: medical futility for the trauma patient

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Abstract
Despite years of research on the resuscitation of the patient with critical traumatic injuries, controversy remains surrounding the criteria to waive initiation of resuscitation in the pre-hospital setting or to terminate such efforts in the emergency department. The decision to initiate or continue resuscitation on moribund trauma patients is associated with considerable costs. Ambulance transport using lights and sirens carries potential risk. Emergency department thoracotomy, with exposure to high risk bodily fluids, involvement of numerous staff, and usage precious blood products, is a procedure that has fewer and fewer indications. This review presents guidelines to help determine when to initiate resuscitation for the critically injured trauma patient and when to cease these efforts in the emergency department. Since there are economic, societal, and ethical implications, each system should establish their own criteria, using these guidelines as a basis.