Bioethics Blogs

Responding to Ebola: Questions about Resuscitation

While details of the deaths of patients in Dallas and Madrid from Ebola are not public, their passing prompts questions about resuscitation in individuals infected with the virus. To date, this question has not been raised in clinical ethics. We must now consider whether unilateral do-not-resuscitate orders are justified in this discrete clinical circumstance.

To start, we need to ask whether resuscitation is safe. It may not be so in those Ebola patients who have uncontrolled bleeding. In that setting chest compressions could make matters worse and accelerate exsanguination. This could make cardiopulmonary resuscitation (CPR) contraindicated in the minority of patients who have bleeding.

Another major challenge is the feasibility of CPR as it relates to staffing and timing. If a patient arrests, a team would have to arrive and suit up in protective gear before resuscitation could safely begin. (No one should expect that physicians, nurses, and respiratory therapists should just rush in, as is the norm, for “conventional” codes. If society harbored such expectation, we would encounter work force issues and no one would volunteer to provide care.)

Beyond the question of whether CPR is indicated is one of logistics. Arriving at the room of a patient in cardiac arrest and suiting up could lead to a delay of several minutes, raising the risk of hypoxic brain injury or anoxia for patients who are not yet intubated. This raises questions about the futility and utility of resuscitative intervention itself, in addition to the intrinsic lethality of the disease by the time there is hemodynamic collapse.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.