The use of a clinical prediction rule for the termination of resuscitation may help clinicians decide whether to terminate basic life support resuscitative efforts in patients having an out-of-hospital cardiac arrest.

Background Previous research has demonstrated significant relationships between peri-shock pause and survival to discharge from out-of-hospital shockable cardiac arrest (OHCA). Objective To determine the impact of peri-shock pause on survival from OHCA during the ROC PRIMED randomized controlled trial. Methods We included patients in the ROC PRIMED trial who suffered OHCA between June 2007 and November 2009, presented with a shockable rhythm and had CPR process data for at least one shock. We used multivariable logistic regression to determine the association between peri-shock pause duration and survival to hospital discharge. Results Among 2006 patients studied, the median (IQR) shock pause duration was: pre-shock pause 15 s (8, 22); post-shock pause 6 s (4, 9); and peri-shock pause 22.0 s (14, 31). After adjusting for Utstein predictors of survival as well as CPR quality measures, the odds of survival to hospital discharge were significantly higher for patients with pre-shock pause <10 s (OR: 1.52, 95% CI: 1.09, 2.11) and peri-shock pause <20 s (OR: 1.82, 95% CI: 1.17, 2.85) when compared to patients with pre-shock pause ≥20 s and peri-shock pause ≥40 s. Post-shock pause was not significantly associated with survival to hospital discharge. Results for neurologically intact survival (Modified Rankin Score ≤ 3) were similar to our primary outcome. Conclusions In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial, shorter pre- and peri-shock pauses were significantly associated with higher odds of survival. Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses.

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Many of these countries have a nationwide surveillance or a nationally coordinated system to manage patients with out-of-hospital emergencies. In these contexts, it is possible that quality improvement initiatives could be designed and translated more effectively, leading to improved survival for OHCA patients. It remains unclear whether findings from these studies are applicable in North America, where emergency medical services are organized by smaller jurisdictions and patients are managed by hundreds of destination hospitals. 2 In Ontario, for example, the population of 13.8 million is served by 53 individual land-based emergency medical service providers, with ≈280 destination hospitals providing postarrest care. 8 Population-level surveillance studies are critical to inform policy and evaluate current systems of care.Background-Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis and poses a significant burden to the healthcare system, but few studies have evaluated whether OHCA incidence and survival have changed over time. Methods and Results-A population-based cohort study was conducted, including 34 291 OHCA patients >20 years of age who were transported alive to the emergency department of an acute-care hospital from April 1, 2002, to March 31, 2012 Patients with life-threatening trauma and those who died before hospital arrival were excluded. The overall age-and sex-standardized incidence of OHCA patients who were transported alive was 36 cases per 100 000 persons and did not significantly change over the study period. Cardiac risk factor prevalence increased significantly, whereas the rate of most cardiovascular conditions decreased significantly. The 30-day survival improved from 9.4% in 2002 to 13.6% in 2011; 1-year survival improved from 7.7% to 11.8% (P<0.001). Patients hospitalized in 2011 were significantly more likely to survive 30 days (adjusted odds ratio, 1.47 [95% CI, 1.22-1.77]) and 1 year (adjusted odds ratio, 1.55 [95% CI, 1.27-1.91]) compared with 2002. A significant interaction between temporal trends in survival improvement and age group was observed in which the improvement in survival was largest in the youngest age groups. Conclusions-OHCA patients who were transported alive are increasingly likely to have cardiovascular risk factors but less likely to have previous cardiovascular conditions. The overall incidence of OHCA patients transported to hospital alive did not change over the past decade. Short-and longer-term survival after OHCA has substantially improved, with younger patients experiencing the greatest improvement. Accordingly, the main objective of this study was to evaluate recent trends in the patient characteristics, incidence, and the survival of patients after OHCA. Methods Data SourcesOur analytic data sets were created by linking together multiple large administrative databases in Ontario using unique encrypted patient identification numbers to protect patient confidentiality. The Canadian Institute of Health Information Discharge Abstract...

A short course of prednisone reduced early relapse rates after the treatment of acute asthma in the emergency room, an effect limited to the period of steroid administration.

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Survival after OHCA has improved over time. This trend was associated with improved rates of bystander CPR, automated external defibrillator use, high-quality CPR metrics, and in-hospital targeted temperature management. The results suggest that multiple factors, each improving over time, may have contributed to the observed increase in survival.