Dead On Arrival - Medical D.O.A.

Medical D.O.A.

When presented with a pulseless patient, medical professionals are required to perform cardiopulmonary resuscitation (CPR) unless specific conditions are met which allow them to pronounce the patient as deceased. For example, in most places, these are examples of such criteria:

• Injuries not compatible with life. These include but are not necessarily limited to decapitation or other catastrophic brain trauma, incineration, severed body, and injuries that do not permit effective administration of CPR. If a patient is presenting with any of these conditions, it should be intuitively obvious that the patient is non-viable.
• Rigor mortis, indicating that the patient has been dead for at least a few hours. Rigor mortis can sometimes be difficult to determine, so it is often used reported along with other determining factors.
• Obvious decomposition.
• Lividity, indicating that the body has been pulseless and in the same position long enough for blood to sink and collect within the body, creating purplish discolorations at the lowest points of the body (with respect to gravity).
• Stillbirth. If it can be determined without a doubt that an infant died prior to birth, as indicated by skin blisters, an unusually soft head, and an extremely offensive odor, resuscitation should not be attempted. If there is even the slightest hope that the infant is viable, CPR should be initiated; some jurisdictions maintain that life-saving efforts should be attempted on all infants to assure parents that all possible actions were performed to save their child, futile as the medical professionals may have known them to be.
• Identification of valid Do Not Resuscitate orders.

This list may not be a comprehensive picture of medical practice in all jurisdictions or conditions. For example, it may not represent the standard of care for patients with terminal diseases such as advanced cancer. In addition, jurisdictions such as Texas permit withdrawal of medical care from patients who are deemed unlikely to recover.

Regardless of the patient, pronouncement of death must always be made with absolute certainty and only after it has been determined that the patient is not a candidate for resuscitation. This type of decision is rather sensitive, and can be difficult to make.

Legal definitions of death vary from place to place, for example irreversible brain death, prolonged clinical death, etc.