Termination-of-resuscitation rules validated in cardiac arrest

Termination-of-resuscitation rules validated in cardiac arrest

24 September 2008

MedWire News: US researchers have validated two rules for identifying patients with out-of-hospital cardiac arrest (OHCA) who have little or no chance of survival.

The termination-of-resuscitation rules, developed by the Ontario Prehospital Life Support group, cover responders providing basic life support (BLS) and those providing advanced life support (ALS) to patients with OHCA.

The BLS rule has three criteria: event not witnessed by emergency medical services personnel; no automated external defibrillator used or manual shock applied in out-of-hospital setting; and no return of spontaneous circulation in out-of-hospital setting.

The ALS rule includes the BLS rule plus two additional criteria: arrest not witnessed by bystander; and no bystander-administered cardiopulmonary resuscitation.

The aim of the present study, by Comilla Sasson (University of Michigan, Ann Arbor) and team, was to validate the two rules using surveillance data prospectively submitted by emergency medical systems and hospitals in eight US cities between 2005 and 2008.

Sasson retrospectively applied the rules to 5505 adults with OHCA, 392 (7.1%) of whom survived to hospital discharge.

Of 2592 patients who met the BLS criteria, just five (0.2%) survived to discharge. The BLS rule therefore had a specificity of 0.987 and a positive predictive value of 0.998 for predicting mortality.

Of 1192 patients who met the ALS criteria, none survived to discharge. Accordingly, the ALS rule had a specificity of 1.000 and positive predictive value of 1.000.

"Had either rule been used to guide decisions to cease resuscitative efforts in the out-of-hospital setting, emergency medical systems could have substantially reduced the rate of emergency transports without appreciably worsening the rate of cardiac arrest survival," Sasson et al conclude.

"A prospective study is warranted to assess how well emergency medical systems implement either the BLS or ALS rule in clinical practice."

The study is reported in the Journal of the American Medical Association.

JAMA 2008; 300: 1432-1438