Validation of a Universal Rule for Termination of Resuscitation in the Field

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Validation of a Universal Rule for Termination of Resuscitation in

the

Field

No survivors would have been missed if the rule had been applied to

this

study's large sample of out-of-hospital cardiac arrest cases with

presumed

cardiac etiology.

Survival rates for patients with out-of-hospital cardiac arrest

remain

below 10%. Investigators in Canada conducted a retrospective,

external

validation of a previously described decision rule (JW Emerg Med Aug

25

2006) that recommends termination of resuscitation efforts in the

field if

all three of the following criteria are met: no shock delivered, no

return

of spontaneous circulation, and arrest not witnessed by emergency

medical

services personnel.

The investigators reviewed arrest characteristics and outcomes data

for

2415 consecutive adult patients (mean age, 69; 63% men) who were

treated

by

the Toronto area EMS system for out-of-hospital cardiac arrest of

presumed

cardiac etiology between April 2006 and April 2007. Overall, 130

patients

(5.3%) survived to hospital discharge. Analysis showed that, had the

decision rule been applied, no survivors would have been missed

(specificity, 100%; positive predictive value, 100%), and the

transport

rate would have been 54% lower.

Comment: Use of this simple rule would avoid transport of half of

patients

with cardiogenic out-of-hospital cardiac arrest, without missing any

survivors. A lower rate of lights-and-sirens transport would be safer

for

both EMS crews and the public. Although ideally the rule should be

applied

prospectively to a large population of patients with out-of-hospital

arrest, EMS systems should carefully examine this study's findings

and

consider implementing this rule now.

-- J. Pallin, MD, MPH

Dr. Pallin is an attending physician in the Department of Emergency

Medicine at Brigham and Women's Hospital in Boston and in the

Division of

Emergency Medicine at Children's Hospital Boston. He is also an

Assistant

Professor of Medicine (Emergency Medicine) and of Pediatrics at

Harvard

Medical School.

Published in Journal Watch Emergency Medicine April 10, 2009

Citation(s):

on LJ et al. Validation of a universal prehospital termination

of

resuscitation clinical prediction rule for advanced and basic life

support

providers. Resuscitation 2009 Mar; 80:324. (Free)

Louis N. Molino, Sr., CET

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