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01-06-2018 | Review

Ethical challenges in resuscitation

Authors: Spyros D. Mentzelopoulos, Anne-Marie Slowther, Zoe Fritz, Claudio Sandroni, Theodoros Xanthos, Clifton Callaway, Gavin D. Perkins, Craig Newgard, Eleni Ischaki, Robert Greif, Erwin Kompanje, Leo Bossaert

Published in: Intensive Care Medicine | Issue 6/2018

Abstract

Purpose

A rapidly evolving resuscitation science provides more effective treatments to an aging population with multiple comorbidites. Concurrently, emergency care has become patient-centered. This review aims to describe challenges associated with the application of key principles of bioethics in resuscitation and post-resuscitation care; propose actions to address these challenges; and highlight the need for evidence-based ethics and consensus on ethical principles interpretation.

Methods

Following agreement on the article’s outline, subgroups of 2–3 authors provided narrative reviews of ethical issues concerning autonomy and honesty, beneficence/nonmaleficence and dignity, justice, specific practices/circumstances such as family presence during resuscitation, and emergency research. Proposals for addressing ethical challenges were also offered.

Results

Respect for patient autonomy can be realized through honest provision of information, shared decision-making, and advance directives/care planning. Essential prerequisites comprise public and specific healthcare professionals’ education, appropriate regulatory provisions, and allocation of adequate resources. Regarding beneficence/nonmaleficence, resuscitation should benefit patients, while avoiding harm from futile interventions; pertinent practice should be based on neurological prognostication and patient/family-reported outcomes. Regarding dignity, aggressive life-sustaining treatments against patients preferences should be avoided. Contrary to the principle of justice, resuscitation quality may be affected by race/income status, age, ethnicity, comorbidity, and location (urban versus rural or country-specific/region-specific). Current evidence supports family presence during resuscitation. Regarding emergency research, autonomy should be respected without hindering scientific progress; furthermore, transparency of research conduct should be promoted and funding increased.

Conclusions

Major ethical challenges in resuscitation science need to be addressed through complex/resource-demanding interventions. Such actions require support by ongoing/future research.

Available only for authorised users

Mentzelopoulos SD, Haywood K, Cariou A, Mantzanas M, Bossaert L (2016) Evolution of medical ethics in resuscitation and end of life. Trends Anaesth Crit Care 10:7–14CrossRef

Parsa-Parsi RW (2017) The revised declaration of Geneva: a modern-day physician’s pledge. JAMA 318:1971–1972. https://doi.org/10.1001/jama.2017.16230 CrossRefPubMed

Bossaert LL, Perkins GD, Askitopoulou H, Raffay VI, Greif R, Haywood KL, Mentzelopoulos SD, Nolan JP, Van de Voorde P, Xanthos TT, Ethics of resuscitation and end-of-life decisions section Collaborators (2015) European resuscitation council guidelines for resuscitation 2015: section 11. The ethics of resuscitation and end-of-life decisions. Resuscitation 95:302–311. https://doi.org/10.1016/j.resuscitation.2015.07.033 CrossRefPubMed

Australian Resuscitation Council; New Zealand Resuscitation Council (2015) Section 10: guideline 10.5—legal and ethical issues related to resuscitation. Australian Resuscitation Council website. https://resus.org.au/guidelines/. Accessed 9 May 2018

Mentzelopoulos SD, Bossaert L, Raffay V, Askitopoulou H, Perkins GD, Greif R, Haywood K, Van de Voorde P, Xanthos T (2016) A survey of key opinion leaders on ethical resuscitation practices in 31 European countries. Resuscitation 100:11–17. https://doi.org/10.1016/j.resuscitation.2015.12.010 CrossRefPubMed

Mancini ME, Diekema DS, Hoadley TA, Kadlec KD, Leveille MH, McGowan JE, Munkwitz MM, Panchal AR, Sayre MR, Sinz EH (2015) Part 3: ethical issues: 2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132(18 Suppl 2):S383–S396. https://doi.org/10.1161/CIR.0000000000000254 CrossRefPubMed

O’Neill O (1984) Paternalism and partial autonomy. J Med Ethics 10:173–178CrossRefPubMedPubMedCentral

Fritz Z, Slowther AM, Perkins GD (2017) Resuscitation policy should focus on the patient, not the decision. BMJ 356:j813. https://doi.org/10.1136/bmj.j813 CrossRefPubMedPubMedCentral

Kon AA, Davidson JE, Morrison W, Danis M, White DB, American College of Critical Care Medicine; American Thoracic Society (2016) Shared decision making in ICUs: an American college of critical care medicine and american thoracic society policy statement. Crit Care Med 44:188–201. https://doi.org/10.1097/CCM.0000000000001396 CrossRefPubMedPubMedCentral

10.

Council of Europe (2014) Guide on the decision-making process regarding medical treatment in end-of-life situations. Bioethics.net website. http://www.bioethics.net/2014/05/council-of-europe-launches-guide-on-decision-making-process-regarding-medical-treatment-in-end-ofllife-situations/. Accessed 9 May 2018

11.

Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VR, Deakin CD, Bottiger BW, Friberg H, Sunde K, Sandroni C (2015) European resuscitation council and European society of intensive care medicine guidelines for post-resuscitation care 2015: section 5 of the European resuscitation council guidelines for resuscitation 2015. Resuscitation 95:202–222. https://doi.org/10.1016/j.resuscitation.2015.07.018 CrossRefPubMed

12.

Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, Bossaert LL, Brett SJ, Chamberlain D, de Caen AR, Deakin CD, Finn JC, Gräsner JT, Hazinski MF, Iwami T, Koster RW, Lim SH, Ma MH, McNally BF, Morley PT, Morrison LJ, Monsieurs KG, Montgomery W, Nichol G, Okada K, Ong ME, Travers AH, Nolan JP, Collaborators Utstein (2015) Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American heart association emergency cardiovascular care committee and the council on cardiopulmonary, critical care, perioperative and resuscitation. Resuscitation 96:328–340. https://doi.org/10.1016/j.resuscitation.2014.11.002 CrossRefPubMed

13.

Mentzelopoulos SD, Mantzanas M, van Belle G, Nichol G (2015) Evolution of European union legislation on emergency research. Resuscitation 91:84–91. https://doi.org/10.1016/j.resuscitation.2015.03.006 CrossRefPubMed

14.

Booth MG (2007) Informed consent in emergency research: a contradiction in terms. Sci Eng Ethics 13:351–359. https://doi.org/10.1007/s11948-007-9028-3 CrossRefPubMed

15.

Kompanje EJ, Maas AI, Menon DK, Kesecioglu J (2014) Medical research in emergency research in the European Union member states: tensions between theory and practice. Intensive Care Med 40:496–503. https://doi.org/10.1007/s00134-014-3243-6 CrossRefPubMed

16.

Gibbs AJO, Malyon AC, Fritz ZBM (2016) Themes and variations: an exploratory international investigation into resuscitation decision-making. Resuscitation 103:75–81. https://doi.org/10.1016/j.resuscitation.2016.01.020 CrossRefPubMedPubMedCentral

17.

Sprung CL, Truog RD, Curtis JR, Joynt GM, Baras M, Michalsen A, Briegel J, Kesecioglu J, Efferen L, De Robertis E, Bulpa P, Metnitz P, Patil N, Hawryluck L, Manthous C, Moreno R, Leonard S, Hill NS, Wennberg E, McDermid RC, Mikstacki A, Mularski RA, Hartog CS, Avidan A (2014) Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The consensus for worldwide end-of-life practice for patients in intensive care units (welpicus) study. Am J Respir Crit Care Med 190:855–866. https://doi.org/10.1164/rccm.201403-0593CC CrossRefPubMed

18.

Enes S (2003) An exploration of dignity in palliative care. Palliat Med 17:263–269CrossRefPubMed

19.

Martin DK, Emanuel LL, Singer PA (2000) Planning for the end of life. Lancet 356:1672–1676CrossRefPubMed

20.

Andorno R, Biller-Andorno N, Brauer S (2009) Advance health care directives: towards a coordinated European policy? Eur J Health Law 16:207–227CrossRefPubMed

21.

Fagerlin A, Schneider CE (2004) Enough: the failure of the living will. Hastings Cent Rep 34:30–42CrossRefPubMed

22.

Sulmasy DP (2018) Italy’s new advance directive law: when in Rome…. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2018.0462 PubMedCrossRef

23.

Mower WR, Baraff LJ (1993) Advance directives, effect of type of directive on physicians therapeutic decisions. Arch Intern Med 153:375–381CrossRefPubMed

24.

Ryan CJ (1996) Betting your life: an argument against certain advance directives. J Med Ethics 22:95–99CrossRefPubMedPubMedCentral

25.

Wittink MN, Morales KH, Meoni LA, Ford DE, Wang NY, Klag MJ, Gallo JJ (2008) Stability of preferences for end-of-life treatment after 3 years of follow-up: the Johns Hopkins precursors study. Arch Intern Med 168:2125–2130. https://doi.org/10.1001/archinte.168.19.2125 CrossRefPubMedPubMedCentral

26.

Puchalski CM, Zhong Z, Jacobs MM, Fox E, Lynn J, Harrold J, Galanos A, Phillips RS, Califf R, Teno JM (2000) Patients who want their family and physician to make resuscitation decisions for them: observations from support and help. Study to understand prognoses and preferences for outcomes and risks of treatment. hospitalized elderly longitudinal project. J Am Geriatr Soc 48(5 Suppl):S84–S90CrossRefPubMed

27.

Silveira MJ, Kim SY, Langa KM (2010) Advance directives and outcomes of surrogate decision making before death. N Engl J Med 362:1211–1218. https://doi.org/10.1056/NEJMsa0907901 CrossRefPubMedPubMedCentral

28.

Brinkman-Stoppelenburg A, Rietjens JA, van der Heide A (2014) The effects of advance care planning on end-of-life care: a systematic review. Palliat Med 28:1000–1025. https://doi.org/10.1177/0269216314526272 CrossRefPubMed

29.

Vandervoort A, Houttekier D, Van den Block L, van der Steen JT, Vander Stichele R, Deliens L (2014) Advance care planning and physician orders in nursing home residents with dementia: a nationwide retrospective study among professional caregivers and relatives. J Pain Symptom Manage 47:245–256. https://doi.org/10.1016/j.jpainsymman.2013.03.009 CrossRefPubMed

30.

[No authors listed] (2017) Guidelines for emergency physicians on the interpretation of physician orders for life-sustaining therapy (POLST). Ann Emerg Med. 7012212510.1016/j.annemergmed.2017.04.046

31.

Tolle SW, Teno JM (2017) Lessons from Oregon in embracing complexity in end-of-life care. N Engl J Med 376:1078–1082. https://doi.org/10.1056/NEJMsb1612511 CrossRefPubMed

32.

Fritz Z, Fuld J (2010) Ethical issues surrounding do not attempt resuscitation orders: decisions, discussions and deleterious effects. J Med Ethics 36:593–597. https://doi.org/10.1136/jme.2010.035725 CrossRefPubMed

33.

Convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine: convention on human rights and biomedicine. Oviedo, 4.IV.1997. http://conventions.coe.int/Treaty/en/Treaties/Html/164.htm. Accessed 9 May 2018

34.

Ebell MH, Jang W, Shen Y, Geocadin RG, Get With The Guidelines-Resuscitation Investigators (2013) Development and validation of the good outcome following attempted resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation. JAMA Intern Med 173:1872–1878. https://doi.org/10.1001/jamainternmed.2013.10037 CrossRefPubMed

35.

Scheunemann LP, Arnold RM, White DB (2012) The facilitated values history: helping surrogates make authentic decisions for incapacitated patients with advanced illness. Am J Respir Crit Care Med 186:480–486. https://doi.org/10.1164/rccm.201204-0710CP CrossRefPubMedPubMedCentral

36.

Griffith DM, Salisbury LG, Lee RJ, Lone N, Merriweather JL, Walsh TS, RECOVER Investigators (2018) Determinants of health-related quality of life after ICU: importance of patient demographics, previous comorbidity, and severity of illness. Crit Care Med 46:594–601. https://doi.org/10.1097/CCM.0000000000002952 CrossRefPubMed

37.

Venkat A, Becker J (2014) The effect of statutory limitations on the authority of substitute decision makers on the care of patients in the intensive care unit: case examples and review of state laws affecting withdrawing or withholding life-sustaining treatment. J Intensive Care Med 29:71–80. https://doi.org/10.1177/0885066611433551 CrossRefPubMed

38.

Schenker Y, Tiver GA, Hong SY, White DB (2012) Association between physicians beliefs and the option of comfort care for critically ill patients. Intensive Care Med 38:1607–1615CrossRefPubMedPubMedCentral

39.

Anesi GL, Halpern SD (2016) Choice architecture in code status discussions with terminally ill patients and their families. Intensive Care Med 42:1065–1067. https://doi.org/10.1007/s00134-016-4294-7 CrossRefPubMedPubMedCentral

40.

Ernecoff NC, Curlin FA, Buddadhumaruk P, White DB (2015) Health care professionals responses to religious or spiritual statements by surrogate decision makers during goals-of-care discussions. JAMA Intern Med 175(10):1662–1669. https://doi.org/10.1001/jamainternmed.2015.4124 CrossRefPubMed

41.

Stirrat GM, Gill R (2005) Autonomy in medical ethics after O’Neill. J Med Ethics 31:127–130CrossRefPubMedPubMedCentral

42.

Lipkus IM (2007) Numeric, verbal, and visual formats of conveying health risks: suggested best practices and future recommendations. Med Decis Making 27:696–713CrossRefPubMed

43.

Periyakoil VS, Neri E, Fong A, Kraemer H (2014) Do unto others: doctors personal end-of-life resuscitation preferences and their attitudes toward advance directives. PLoS One 9:e98246. https://doi.org/10.1371/journal.pone.0098246 CrossRefPubMedPubMedCentral

44.

Richard C, Lajeunesse Y, Lussier MT (2010) Therapeutic privilege: between the ethics of lying and the practice of truth. J Med Ethics 36:353–357. https://doi.org/10.1136/jme.2009.033340 CrossRefPubMed

45.

Gräsner JT, Lefering R, Koster RW, Masterson S, Böttiger BW, Herlitz J, Wnent J, Tjelmeland IB, Ortiz FR, Maurer H, Baubin M, Mols P, Hadžibegovíc I, Ioannides M, Škulec R, Wissenberg M, Salo A, Hubert H, Nikolaou NI, Lóczi G, Svavarsdóttir H, Semeraro F, Wright PJ, Clarens C, Pijls R, Cebula G, Correia VG, Cimpoesu D, Raffay V, Trenkler S, Markota A, Strömsöe A, Burkart R, Perkins GD, Bossaert LL, EuReCa ONE Collaborators (2016) EuReCa ONE-27 Nations, ONE Europe, ONE Registry: a prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: a prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation 105:188–195. https://doi.org/10.1016/j.resuscitation.2016.06.004 CrossRefPubMed

46.

Daya MR, Schmicker RH, Zive DM, Rea TD, Nichol G, Buick JE, Brooks S, Christenson J, MacPhee R, Craig A, Rittenberger JC, Davis DP, May S, Wigginton J, Wang H, Resuscitation Outcomes Consortium Investigators (2015) Out-of-hospital cardiac arrest survival improving over time: results from the resuscitation outcomes consortium (ROC). Resuscitation. 91:108–115. https://doi.org/10.1016/j.resuscitation.2015.02.003 CrossRefPubMedPubMedCentral

47.

Beck B, Bray J, Cameron P, Smith K, Walker T, Grantham H, Hein C, Thorrowgood M, Smith A, Inoue M, Smith T, Dicker B, Swain A, Bosley E, Pemberton K, McKay M, Johnston-Leek M, Perkins GD, Nichol G, Finn J, Aus-ROC Steering Committee (2018) Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: results from the Aus-ROC Epistry. Resuscitation 126:49–57. https://doi.org/10.1016/j.resuscitation.2018.02.029 CrossRefPubMed

48.

Pichler G, Fazekas F (2016) Cardiopulmonary arrest is the most frequent cause of the unresponsive wakefulness syndrome: a prospective population-based cohort study in Austria. Resuscitation 103:94–98. https://doi.org/10.1016/j.resuscitation.2016.02.023 CrossRefPubMed

49.

Andrew E, Mercier E, Nehme Z, Bernard S, Smith K (2018) Long-term functional recovery and health-related quality of life of elderly out-of-hospital cardiac arrest survivors. Resuscitation 126:118–124. https://doi.org/10.1016/j.resuscitation.2018.03.017 CrossRefPubMed

50.

Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS, American Heart Association Get with the Guidelines-Resuscitation Investigators (2012) Trends in survival after in-hospital cardiac arrest. N Engl J Med 367:1912–1920. https://doi.org/10.1056/NEJMoa1109148 CrossRefPubMedPubMedCentral

51.

Merchant RM, Berg RA, Yang L, Becker LB, Groeneveld PW, Chan PS, American Heart Association’s Get With the Guidelines-Resuscitation Investigators (2014) Hospital variation in survival after in-hospital cardiac arrest. J Am Heart Assoc 3:e000400. https://doi.org/10.1161/JAHA.113.000400 CrossRefPubMedPubMedCentral

52.

Nolan JP, Sandroni C (2017) In this patient in refractory cardiac arrest should I continue CPR for longer than 30 min and if so, how? Intensive Care Med 43:1501–1503. https://doi.org/10.1007/s00134-017-4745-9 CrossRefPubMed

53.

Sandroni C, Cariou A, Cavallaro F, Cronberg T, Friberg H, Hoedemaekers C, Horn J, Nolan JP, Rossetti AO, Soar J (2014) Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European resuscitation council and the european society of intensive care medicine. Intensive Care Med 40:1816–1831. https://doi.org/10.1007/s00134-014-3470-x CrossRefPubMedPubMedCentral

54.

Sandroni C, Nolan JP (2015) Neuroprognostication after cardiac arrest in Europe: new timings and standards. Resuscitation 90:A4–A5. https://doi.org/10.1016/j.resuscitation.2015.02.020 CrossRefPubMed

55.

Smith K, Andrew E, Lijovic M, Nehme Z, Bernard S (2015) Quality of life and functional outcomes 12 months after out-of-hospital cardiac arrest. Circulation 131:174–181. https://doi.org/10.1161/CIRCULATIONAHA.114.011200 CrossRefPubMed

56.

Lilja G, Nielsen N, Bro-Jeppesen J, Dunford H, Friberg H, Hofgren C, Horn J, Insorsi A, Kjaergaard J, Nilsson F, Pelosi P, Winters T, Wise MP, Cronberg T (2018) Return to work and participation in society after out-of-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes 11(1):e003566. https://doi.org/10.1161/CIRCOUTCOMES.117.003566 CrossRefPubMed

57.

Calvert M, Kyte D, Mercieca-Bebber R, Slade A, Chan AW, King MT, Hunn A, Bottomley A, Regnault A, Chan AW, Ells C, O’Connor D, Revicki D, Patrick D, Altman D, Basch E, Velikova G, Price G, Draper H, Blazeby J, Scott J, Coast J, Norquist J, Brown J, Haywood K, Johnson LL, Campbell L, Frank L, von Hildebrand M, Brundage M, Palmer M, Kluetz P, Stephens R, Golub RM, Mitchell S, Groves T, The SPIRIT-PRO group (2018) Guidelines for inclusion of patient-reported outcomes in clinical trial protocols: the SPIRIT-PRO extension. JAMA 319:483–494. https://doi.org/10.1001/jama.2017.21903 CrossRefPubMed

58.

Kompanje EJO, Piers RD, Benoit DD (2013) Causes and consequences of disproportionate care in intensive care medicine. Curr Opin Crit Care 19:630–635. https://doi.org/10.1097/MCC.0000000000000026 PubMedCrossRef

59.

Epker JL, Bakker J, Kompanje EJO (2011) The use of opioids and sedatives and time of death after withdrawing mechanical ventilation and vasoactive drugs in a Dutch intensive care unit. Anesth Analg 112:628–634. https://doi.org/10.1213/ANE.0b013e31820ad4d9 CrossRefPubMed

60.

Bakker J, Jansen TC, Lima A, Kompanje EJ (2008) Why opioids and sedatives may prolong life rather than hasten death after ventilator withdrawal in critically ill patients. Am J Hosp Palliat Care 25:152–154. https://doi.org/10.1177/1049909108315511 CrossRefPubMed

61.

Berdowski J, Berg RA, Tijssen JG, Koster RW (2010) Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation 81:1479–1487. https://doi.org/10.1016/j.resuscitation.2010.08.006 CrossRefPubMed

62.

Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, Rea T, Lowe R, Brown T, Dreyer J, Davis D, Idris A, Stiell I, Resuscitation outcomes consortium investigators (2008) Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 300:1423–1431. https://doi.org/10.1001/jama.300.12.1423 CrossRefPubMedPubMedCentral

63.

Sasson C, Magid DJ, Chan P, Root ED, McNally BF, Kellermann AL, Haukoos JS, CARES Surveillance Group (2012) Association of neighborhood characteristics with bystander-initiated CPR. N Engl J Med 367:1607–1615CrossRefPubMedPubMedCentral

64.

Lamhaut L, Hutin A, Puymirat E, Jouan J, Raphalen JH, Jouffroy R, Jaffry M, Dagron C, An K, Dumas F, Marijon E, Bougouin W, Tourtier JP, Baud F, Jouven X, Danchin N, Spaulding C, Carli P (2017) A pre-hospital extracorporeal cardio pulmonary resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: an observational study and propensity analysis. Resuscitation 117:109–117. https://doi.org/10.1016/j.resuscitation.2017.04.014 CrossRefPubMed

65.

Vogel L (2011) Can rationing possibly be rational? CMAJ 183:1242–1243. https://doi.org/10.1503/cmaj.109-3932 CrossRefPubMedPubMedCentral

66.

Arora C, Savulescu J, Maslen H, Selgelid M, Wilkinson D (2016) The intensive care lifeboat: a survey of lay attitudes to rationing dilemmas in neonatal intensive care. BMC Med Ethics 17:69CrossRefPubMedPubMedCentral

67.

Callaway CW (2014) Studying community consultation in exception from informed consent trials. Crit Care Med 42:451–453. https://doi.org/10.1097/CCM.0b013e3182a51f37 CrossRefPubMedPubMedCentral

68.

Nelson MJ, Deiorio NM, Schmidt TA, Zive DM, Griffiths D, Newgard CD (2013) Why persons choose to opt out of an exception from informed consent cardiac arrest trial. Resuscitation 84:825–830. https://doi.org/10.1016/j.resuscitation.2013.01.030 CrossRefPubMedPubMedCentral

69.

Jansen TC, Bakker J, Kompanje EJ (2010) Inability to obtain deferred consent due to early death in emergency research: effect on validity of clinical trial results. Intensive Care Med 36:1962–1965. https://doi.org/10.1007/s00134-010-1988-0.PMID:20689926/ CrossRefPubMedPubMedCentral

70.

Moorthy VS, Karam G, Vannice KS, Kieny MP (2015) Rationale for WHO’s new position calling for prompt reporting and public disclosure of interventional clinical trial results. PLoS Med 12:e1001819. https://doi.org/10.1371/journal.pmed.1001819 CrossRefPubMedPubMedCentral

71.

Ornato JP, Becker LB, Weisfeldt ML, Wright BA (2010) Cardiac arrest and resuscitation: an opportunity to align research prioritization and public health need. Circulation 122:1876–1879. https://doi.org/10.1161/CIRCULATIONAHA.110.963991 CrossRefPubMed

72.

Melltorp G, Nilstun T (1997) The difference between withholding and withdrawing life-sustaining treatment. Intensive Care Med 23:1264–1267CrossRefPubMed

73.

Kiley R, Peatfield T, Hansen J, Reddington F (2017) Data sharing from clinical trials—a research funder’s perspective. N Engl J Med 377:1990–1992. https://doi.org/10.1056/NEJMsb1708278 CrossRefPubMed

74.

Tierney WM, Meslin EM, Kroenke K (2016) Industry support of medical research: important opportunity or treacherous pitfall? J Gen Intern Med 31:228–233. https://doi.org/10.1007/s11606-015-3495-z CrossRefPubMed

Title: Ethical challenges in resuscitation
Authors: Spyros D. Mentzelopoulos
Anne-Marie Slowther
Zoe Fritz
Claudio Sandroni
Theodoros Xanthos
Clifton Callaway
Gavin D. Perkins
Craig Newgard
Eleni Ischaki
Robert Greif
Erwin Kompanje
Leo Bossaert
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 6/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5202-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ethical challenges in resuscitation

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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