Faut-il encore réanimer les arrêts cardiorespiratoires sans témoin ?

Cardiac arrest, mostly related to myocardial ischemia, is the leading cause of death. Life expectancy is precarious and depends strongly on the efficacy of survival chain. In the days after recovery of a stable hemodynamic activity, neurological prognosis may be compromised by physiopathological events cascade. There is a need for determination of simple criteria selecting patients prone not to respond to resuscitation leading to give up unnecessary caring. Among them, the lack of witness associated to other criteria such as initial asystole, allows to predict failure to return to a stable hemodynamic status. Determining accurately the prognosis remains a challenge knowing the heterogeneity in patients, the difference in health care organizations, and the uncertainty of patients' evolution. The use of criteria for deciding to stop resuscitation is therefore questioned. Moreover, organ harvesting could be an additional reason for maintaining adequate organ blood flow in patients with refractory cardiac arrest. Not to resuscitate or not to continue resuscitation of a cardiac arrest occurring without witness is logical but this criterion insufficient and must be associated with other parameters to support the decision.