Ethical and Safety Concerns in Adult and Pediatric Out-of-Hospital Resuscitation

Dear Colleagues,

The coronavirus disease 2019 (COVID-19) pandemic challenges Beauchamp and Childress principles of the biomedical ethics namely autonomy, non-maleficence, beneficence, justice and dignity. Sudden cardiac arrest in the out-of-hospital setting necessitates prompt reaction of bystanders. However, dictated social distancing influences the decisions when to start and when to stop cardiopulmonary resuscitation (CPR). How to assure the safety of rescuers when chest compressions and ventilation attempts have the potential to generate aerosols of a transmissible disease? Advocating chest-only CPR for bystanders may diminish exposure but ventilation is crucial especially in pediatric patients. Potential conflicts are numerous. Discrimination according to a patient’s health status or age must be avoided, but the likelihood of good long-term outcome in nursing home residents may be low. Estimated quality of life may differ substantially between people and advance directives, if available, serve as surrogate for patient’s autonomy. Criteria for withholding or terminating CPR may be influenced by limited access to health care, e.g. the gap between demand and availability of resources such as extracorporeal CPR. The chance of uncontrolled donation after circulation may increase the frequency of organ-preserving CPR. So when to attempt CPR and when to respect the right to die in times of COVID-19 pandemic? And how to improve safety for patients and rescuers?

Research papers and reviews that focus on ethical and safety considerations on adult and pediatric out-of-hospital resuscitation are welcome to this special issue of Medicina, an Open Access Journal from MDPI.

Prof. Dr. Wolfgang Lederer
Guest Editor

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• altruism
• biomedical ethics
• cardiopulmonary resuscitation
• health equity
• paternalism
• patient harm
• right to die
• risk management