Volberg Christian, Politt Katharina, Passon Sebastian, Heuser Nils, Hofacker Elena, Wulf Hinnerk
Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
Institut für angewandte und klinische Ethik im Gesundheitswesen, Dekanat Humanmedizin, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
Med Klin Intensivmed Notfmed. 2025 Apr 29. doi: 10.1007/s00063-025-01271-y.
In the prehospital emergency setting, resuscitation following cardiac arrest is initiated as soon as possible after arrival of the emergency services in order to minimize the no-flow time, i.e., the period during which there is no blood circulation and therefore no oxygen supply to the organs. There is frequently no opportunity to ask relatives about the prespecified or presumed wishes of the patient, e.g., in the form of a living will, until after initiation of emergency medical interventions. If an advance directive stipulates "do not resuscitate" (DNR), then this wish is legally binding for treatment. However, if return of spontaneous circulation (ROSC) has been achieved in the meantime, the treating emergency team faces an ethical dilemma, and patients are often taken to hospital against their prespecified will. This leads to unwanted overtreatment. Based on three case reports, the following article discusses the ethical and legal aspects of palliative extubation after ROSC in patients with a predefined DNR status.
在院前急救环境中，心脏骤停后的复苏应在急救服务到达后尽快开始，以尽量缩短无血流时间，即没有血液循环且因此没有向器官供氧的时间段。在开始紧急医疗干预之前，通常没有机会询问亲属关于患者预先指定或推测的意愿，例如以生前遗嘱的形式。如果预先指示规定“不要复苏”（DNR），那么这个意愿对治疗具有法律约束力。然而，如果在此期间已经实现了自主循环恢复（ROSC），那么进行治疗的急救团队将面临伦理困境，并且患者常常会违背其预先指定的意愿被送往医院。这导致了不必要的过度治疗。基于三例病例报告，以下文章讨论了在具有预先定义的DNR状态的患者中ROSC后姑息性拔管的伦理和法律方面。
