Prehospital Termination of Resuscitation in Cases of Refractory Out-of-Hospital Cardiac Arrest | Emergency Medicine | JAMA | JAMA Network
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1.
Rosamond W, Flegal K, Furie K,  et al.  Heart disease and stroke statistics—2008 update: report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee [published online ahead of print December 17, 2007].  Circulation. 2008;117(4):e25-e14618086926PubMedGoogle ScholarCrossref
2.
Dunne RB, Compton S, Zalenski RJ, Swor R, Welch R, Bock BF. Outcomes from out-of-hospital cardiac arrest in Detroit.  Resuscitation. 2007;72(1):59-6517113209PubMedGoogle ScholarCrossref
3.
Davies CS, Colquhoun MC, Boyle R, Chamberlain DA. A national programme for on-site defibrillation by lay people in selected high risk areas: initial results.  Heart. 2005;91(10):1299-130216162620PubMedGoogle ScholarCrossref
4.
Nichol G, Stiell IG, Laupacis A, Pham B, De Maio VJ, Wells GA. A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest.  Ann Emerg Med. 1999;34(4, pt 1):517-52510499952PubMedGoogle ScholarCrossref
5.
Eisenberg M, Bergner L, Hallstrom A. Paramedic programs and out-of-hospital cardiac arrest, I: factors associated with successful resuscitation.  Am J Public Health. 1979;69(1):30-38420353PubMedGoogle ScholarCrossref
6.
Eisenberg MS, Horwood BT, Cummins RO, Reynolds-Haertle R, Hearne TR. Cardiac arrest and resuscitation: a tale of 29 cities.  Ann Emerg Med. 1990;19(2):179-1862301797PubMedGoogle ScholarCrossref
7.
International Liaison Committee on Resuscitation.  2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with treatment recommendations, part 2: adult basic life support.  Resuscitation. 2005;67(2-3):187-20116324988PubMedGoogle ScholarCrossref
8.
Kirves H, Skrifvars MB, Vahakuopus M, Ekstrom K, Martikainen M, Castren M. Adherence to resuscitation guidelines during prehospital care of cardiac arrest patients.  Eur J Emerg Med. 2007;14(2):75-8117496680PubMedGoogle ScholarCrossref
9.
Bailey ED, Wydro GC, Cone DC.National Association of EMS Physicians Standards and Clinical Practice Committee.  Termination of resuscitation in the prehospital setting for adult patients suffering nontraumatic cardiac arrest.  Prehosp Emerg Care. 2000;4(2):190-19510782611PubMedGoogle ScholarCrossref
10.
Bonnin MJ, Pepe PE, Kimball KT, Clark PS Jr. Distinct criteria for termination of resuscitation in the out-of-hospital setting.  JAMA. 1993;270(12):1457-14628204131PubMedGoogle ScholarCrossref
11.
Eisenberg M, Hallstrom A, Bergner L. The ACLS score: predicting survival from out-of-hospital cardiac arrest.  JAMA. 1981;246(1):50-527241728PubMedGoogle ScholarCrossref
12.
Kellermann AL, Hackman BB, Somes G. Predicting the outcome of unsuccessful prehospital advanced cardiac life support.  JAMA. 1993;270(12):1433-14368371442PubMedGoogle ScholarCrossref
13.
Lindholm DJ, Campbell JP. Predicting survival from out-of-hospital cardiac arrest.  Prehosp Disaster Med. 1998;13(2-4):51-5410346407PubMedGoogle Scholar
14.
Marsden AK, Ng GA, Dalziel K, Cobbe SM. When is it futile for ambulance personnel to initiate cardiopulmonary resuscitation?  BMJ. 1995;311(6996):49-517613330PubMedGoogle ScholarCrossref
15.
Pepe PE, Swor RA, Ornato JP,  et al.  Resuscitation in the out-of-hospital setting: medical futility criteria for on-scene pronouncement of death.  Prehosp Emerg Care. 2001;5(1):79-8711194075PubMedGoogle ScholarCrossref
16.
Petrie DA, De Maio V, Stiell IG, Dreyer J, Martin M, O’Brien JA. Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system.  CJEM. 2001;3(3):186-19217610782PubMedGoogle Scholar
17.
Verbeek PR, Vermeulen MJ, Ali FH, Messenger DW, Summers J, Morrison LJ. Derivation of a termination-of-resuscitation guideline for emergency medical technicians using automated external defibrillators.  Acad Emerg Med. 2002;9(7):671-67812093706PubMedGoogle ScholarCrossref
18.
Herlitz J, Engdahl J, Svensson L, Young M, Angquist KA, Holmberg S. Can we define patients with no chance of survival after out-of-hospital cardiac arrest?  Heart. 2004;90(10):1114-111815367502PubMedGoogle ScholarCrossref
19.
Jaslow D, Barbera JA, Johnson E, Moore W. Termination of nontraumatic cardiac arrest resuscitative efforts in the field: a national survey.  Acad Emerg Med. 1997;4(9):904-9079305433PubMedGoogle ScholarCrossref
20.
Lockey AS. Recognition of death and termination of cardiac resuscitation attempts by UK ambulance personnel.  Emerg Med J. 2002;19(4):345-34712101156PubMedGoogle ScholarCrossref
21.
O’Brien E, Hendricks D, Cone DC. Field termination of resuscitation: analysis of a newly implemented protocol.  Prehosp Emerg Care. 2008;12(1):57-6118189179PubMedGoogle ScholarCrossref
22.
Maguire BJ, Hunting KL, Smith GS, Levick NR. Occupational fatalities in emergency medical services: a hidden crisis.  Ann Emerg Med. 2002;40(6):625-63212447340PubMedGoogle ScholarCrossref
23.
Morrison LJ, Verbeek PR, Vermeulen MJ,  et al.  Derivation and evaluation of a termination of resuscitation clinical prediction rule for advanced life support providers.  Resuscitation. 2007;74(2):266-27517383072PubMedGoogle ScholarCrossref
24.
Morrison LJ, Visentin LM, Kiss A,  et al.  Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest.  N Engl J Med. 2006;355(5):478-48716885551PubMedGoogle ScholarCrossref
25.
SoRelle R. CARES program working to improve cardiac arrest survival.  Emerg Med News.. 2008;30((2):1):10-15Google Scholar
26.
Jacobs I, Nadkarni V, Bahr J,  et al.  Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).  Circulation. 2004;110(21):3385-339715557386PubMedGoogle ScholarCrossref
27.
Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications.  Ann Intern Med. 1990;112(12):949-9542187394PubMedGoogle ScholarCrossref
28.
CARES IRB approval and modification.  Cardiac Arrest Registry to Enhance Survival Web site. https://www.mycares.net/cares_info.jsp. Accessed April 6, 2008
29.
Richman PB, Vadeboncoeur TF, Chikani V, Clark L, Bobrow BJ. Independent evaluation of an out-of-hospital termination of resuscitation (TOR) clinical decision rule.  Acad Emerg Med. 2008;15(6):517-52118616436PubMedGoogle ScholarCrossref
30.
Eckstein M, Stratton SJ, Chan LS. Termination of resuscitative efforts for out-of-hospital cardiac arrests.  Acad Emerg Med. 2005;12(1):65-7015635140PubMedGoogle ScholarCrossref
31.
Marco CA, Schears RM. Prehospital resuscitation practices: a survey of prehospital providers.  J Emerg Med. 2003;24(1):101-10612554050PubMedGoogle ScholarCrossref
32.
Marcus R, Srivastava PU, Bell DM,  et al.  Occupational blood contact among prehospital providers.  Ann Emerg Med. 1995;25(6):776-7797755199PubMedGoogle ScholarCrossref
33.
Cheung M, Morrison L, Verbeek PR. Prehospital vs. emergency department pronouncement of death: a cost analysis.  CJEM. 2001;3(1):19-2217612436PubMedGoogle Scholar
34.
Swor RA, Jackson RE, Tintinalli JE, Pirrallo RG. Does advanced age matter in outcomes after out-of-hospital cardiac arrest in community-dwelling adults?  Acad Emerg Med. 2000;7(7):762-76810917325PubMedGoogle ScholarCrossref
35.
Isaacs E, Callaham ML. Ability of laypersons to estimate short time intervals in cardiac arrest.  Ann Emerg Med. 2000;35(2):147-15410650232PubMedGoogle ScholarCrossref
36.
Hallstrom AP. Should time from cardiac arrest until call to emergency medical services (EMS) be collected in EMS research?  Crit Care Med. 2002;30(4):(suppl)  S127-S13011940786PubMedGoogle ScholarCrossref
37.
Delbridge TR, Fosnocht DE, Garrison HG, Auble TE. Field termination of unsuccessful out-of-hospital cardiac arrest resuscitation: acceptance by family members.  Ann Emerg Med. 1996;27(5):649-6548629788PubMedGoogle ScholarCrossref
38.
Schmidt TA, Harrahill MA. Family response to out-of-hospital death.  Acad Emerg Med. 1995;2(6):513-5187497052PubMedGoogle ScholarCrossref
39.
Feder S, Matheny RL, Loveless RS Jr, Rea TD. Withholding resuscitation: a new approach to prehospital end-of-life decisions.  Ann Intern Med. 2006;144(9):634-64016670132PubMedGoogle ScholarCrossref
40.
Hick JL, Mahoney BD, Lappe M. Factors influencing hospital transport of patients in continuing cardiac arrest.  Ann Emerg Med. 1998;32(1):19-259656944PubMedGoogle ScholarCrossref
41.
Marco CA, Schears RM. Societal opinions regarding CPR.  Am J Emerg Med. 2002;20(3):207-21111992341PubMedGoogle ScholarCrossref
Original Contribution
September 24, 2008

Prehospital Termination of Resuscitation in Cases of Refractory Out-of-Hospital Cardiac Arrest

Author Affiliations

Author Affiliations: Department of Emergency Medicine (Drs Sasson and Macy) and Robert Wood Johnson Clinical Scholars Program (Dr Sasson), University of Michigan, Ann Arbor; Department of Emergency Medicine/Internal Medicine, Henry Ford Health System, Detroit, Michigan (Dr Hegg); and CARES Project (Ms Park) and Department of Emergency Medicine (Drs Kellermann and McNally), Emory University, Atlanta, Georgia.

JAMA. 2008;300(12):1432-1438. doi:10.1001/jama.300.12.1432
Abstract

Context Identifying patients in the out-of-hospital setting who have no realistic hope of surviving an out-of-hospital cardiac arrest could enhance utilization of scarce health care resources.

Objective To validate 2 out-of-hospital termination-of-resuscitation rules developed by the Ontario Prehospital Life Support (OPALS) study group, one for use by responders providing basic life support (BLS) and the other for those providing advanced life support (ALS).

Design, Setting, and Patients Retrospective cohort study using surveillance data prospectively submitted by emergency medical systems and hospitals in 8 US cities to the Cardiac Arrest Registry to Enhance Survival (CARES) between October 1, 2005, and April 30, 2008. Case patients were 7235 adults with out-of-hospital cardiac arrest; of these, 5505 met inclusion criteria.

Main Outcome Measures Specificity and positive predictive value of each termination-of-resuscitation rule for identifying patients who likely will not survive to hospital discharge.

Results The overall rate of survival to hospital discharge was 7.1% (n = 392). Of 2592 patients (47.1%) who met BLS criteria for termination of resuscitation efforts, only 5 (0.2%) patients survived to hospital discharge. Of 1192 patients (21.7%) who met ALS criteria, none survived to hospital discharge. The BLS rule had a specificity of 0.987 (95% confidence interval [CI], 0.970-0.996) and a positive predictive value of 0.998 (95% CI, 0.996-0.999) for predicting lack of survival. The ALS rule had a specificity of 1.000 (95% CI, 0.991-1.000) and positive predictive value of 1.000 (95% CI, 0.997-1.000) for predicting lack of survival.

Conclusion In this validation study, the BLS and ALS termination-of-resuscitation rules performed well in identifying patients with out-of-hospital cardiac arrest who have little or no chance of survival.

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