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SIDS

An interesting and depressing subject came up in medic school recently. We were going through various scenarios where we have a patient that is either found in cardiac arrest (he has no pulse) or goes into arrest while in your care. The main point was to review legal/ethical issues for patients with a DNR order (do-not-resuscitate) or for those that don’t have one, yet express a desire to not be resuscitated. In short, if in any doubt, do CPR. Oh, and for the guy that says “just let me die!”, well, he might die, but then we’re doing CPR — sorry buddy.

Anyway, we eventually exhausted most scenarios, until we arrived at the situation where we find a SIDS baby (sudden infant death syndrome). We are asked what we would do if we arrived on scene and find a baby that is cold to the touch, pale, and has obviously been dead for a while. The parents are hysterical and pleading with you to do CPR. You and your partner know there is absolutely no chance the baby can be brought back. So, what do you do?

We are told that generally the safe thing to do is to start CPR and transport the baby to the hospital in order to make the parents feel that everything was done. The instructor says no harm will be done by doing CPR even if you know it won’t be successful. I disagree.

One, CPR is a brutal thing we do to patients, but we do it because it may save their life. In the case presented to us, it is not medically necessary. Two, the receiving hospital has to have a team ready to accept the baby and do it’s own (futile) interventions. Granted, they probably won’t make a whole-hearted attempt once they hear the full story, but will likely go through the motions anyway. As a result, they won’t be able to care for other potentially critical patients that may have a real chance at life. Finally, by starting CPR we give the family false hope, and they will have to essentially see their baby die a second time when the doctors inevitably stop resuscitation.

I’m not sure what I would do in that situation, and I’m sure the right thing is not cut and dry. A baby that been dead for an hour has no chance, just like an adult, but because it’s a baby we treat the situation differently. I think possibly either response, CPR or no CPR, may be equally right, but it’s a tough call for sure, and one I hope I do not have to make.

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