Derivation and evaluation of a termination of resuscitation clinical prediction rule for advanced life support providers

Morrison, Laurie J.; Verbeek, P. Richard; Vermeulen, Marian J.; Kiss, Alex; Allan, Katherine S.; Nesbitt, Lisa; Stiell, Ian G.

doi:10.1016/j.resuscitation.2007.01.009

Cited by 128 publications

(65 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additional adult studies (LOE P1 616 ; LOE P2 617 ; LOE P5 618 ) showed associations with futility of certain variables such as no ROSC at scene, nonshockable rhythm, unwitnessed arrest, no bystander CPR, call response time, and patient demographics.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 12: Education, Implementation, and Teams

Mancini¹,

Soar²,

Bhanji³

et al. 2010

Circulation

View full text Add to dashboard Cite

Section: Consensus On Sciencementioning

confidence: 99%

Part 12: Education, Implementation, and Teams

Mancini¹,

Soar²,

Bhanji³

et al. 2010

Circulation

View full text Add to dashboard Cite

“…Most of these patients are unlikely to receive benefit from more aggressive prehospital and in-hospital treatment. 27 In addition, gradual implementation of termination of resuscitation rules in communities across Ontario occurred during our study period. For example, the proportion of patients who died on arrival decreased substantially from 24.2% to 6.2% from 2002 to 2011.…”

Section: 19mentioning

confidence: 99%

Trends in Short- and Long-Term Survival Among Out-of-Hospital Cardiac Arrest Patients Alive at Hospital Arrival

et al. 2014

Self Cite

View full text Add to dashboard Cite

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...

show abstract

“…In a previous retrospective analysis of 700 OHCA patients with presumed cardiac etiology, applying the BLS TOR rules demonstrated 100% specificity and 100% positive predictive value (PPV) for identifying non-survivors (i.e., a patient with positive TOR can have resuscitation terminated in the field) (6). The advanced life support (ALS) TOR rules recommend considering the termination of resuscitation when the 3 BLS TOR criteria are met and no bystander cardiopulmonary resuscitation (CPR) was provided (7). The application of the BLS/ALS TOR rule was validated in North American and European sites, and the results consistently showed high specificity and PPV (8,9).…”

mentioning

confidence: 99%