1. European Resuscitation Council

2. Medical ethics An applied discipline based on moral principles that pretends to aid the health professionals in decision making process Ethical principles change with times

3. Ethics and Cardiopulmonary Resuscitation When to start CPR? When to end CPR? Do not attempt resuscitation order (DNAR)

4. When to start CPR? Sudden cardiac and/or respiratory arrest Some possibilities of restoration Recent cardio-respiratory arrest Non terminal illness No evidence of DNAR order Absence of risk In case of doubt - Start Resuscitation!

5. When to end CPR? At least 30 minutes of adequate life support without results n Exceptions : Severe hypothermia, poisoning, VF, invasive monitoring In the newly born, if Apgar at minute 10 is zero Evidence of biological death Other victims with better survival possibilities require CPR There is a DNAR order Rescuer exhausted or in danger

6. The Do Not Attempt Resuscitation Order Anticipated Consider prognosis and expected quality of life Obtain informed consent Order written and visible It can be revoked at any time Palliative care must be assured

7. Multiple ethics aspects of CPR Ethical and legal problems of investigation Use of dead patient as learning material Maintenance of organs for transplantation Use of limited resources Others

8. Presence of parents during resuscitation Parental choice if staff agrees Team member dedicated to them Permits n to be with the dying child (last moment) n to say good bye n to know that efforts were made to save their child

9. Information when a child dies Choose an adequate site to inform Explain immediately and with clear words Permit the parents to see and be with their child Professional and compassionate attitude Try to understand the emotions of parents Delay talking about necropsy studies