Derivation of a Termination‐of‐resuscitation Guideline for Emergency Medical Technicians Using Automated External Defibrillators

Verbeek, P. Richard

doi:10.1197/aemj.9.7.671

Cited by 57 publications

(44 citation statements)

References 30 publications

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“…24 -29 The rule should be applied before moving to the ambulance for transport. 30 This clinical prediction rule consistently generates the highest specificity and positive predictive values when compared to previous guidelines. 29 It is recommended that regional or local EMS authorities use the BLS termination rule to develop protocols for the termination of resuscitative efforts by BLS providers for adult victims of cardiac arrest in areas where advanced life support is not available or may be significantly delayed (Class I, LOE A).…”

Section: Terminating Resuscitative Efforts In a Bls Out-of-hospital Smentioning

confidence: 78%

Part 3: Ethics

Morrison¹,

Kierzek²,

Diekema³

et al. 2010

Circulation

218

161

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Section: Terminating Resuscitative Efforts In a Bls Out-of-hospital Smentioning

confidence: 78%

Part 3: Ethics

Morrison¹,

Kierzek²,

Diekema³

et al. 2010

Circulation

218

161

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“…To overcome these challenges and to standardize the decision-making process, it has been widely debated whether it is possible to define a priori a specific patient group in whom a resuscitation attempt is considered futile. 17,[22][23][24][25] Several proposals have emerged, with one suggestion being the termination of resuscitation rule by Verbeek et al 17 The termination of resuscitation rule is based on 3 prehospital criteria: there has been no ROSC, no shock has been given, and the arrest has not been witnessed by EMS personnel. 17 Inspired by this rule, we retrospectively selected patients and tested 30-day survival if 2 criteria were fulfilled: no ROSC on hospital arrival and no prehospital shock from a defibrillator.…”

Section: Age-related Differencesmentioning

confidence: 99%

“…This was inspired by our earlier study 1 in which the first recorded heart rhythm appeared to be one of the strongest prehospital factors associated with 30-day survival. Furthermore, inspired by the termination of resuscitation rule by Verbeek et al, 17 we tested 30-day survival rate in patients who met 2 criteria: had not achieved ROSC on hospital arrival and had not received a shock from a defibrillator in the prehospital setting.…”

Section: Definition and Recording Of Ohcamentioning

confidence: 99%

Survival After Out-of-Hospital Cardiac Arrest in Relation to Age and Early Identification of Patients With Minimal Chance of Long-Term Survival

et al. 2015

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Background— Survival after out-of-hospital cardiac arrest has increased during the last decade in Denmark. We aimed to study the impact of age on changes in survival and whether it was possible to identify patients with minimal chance of 30-day survival. Methods and Results— Using data from the nationwide Danish Cardiac Arrest Registry (2001─2011), we identified 21 480 patients ≥18 years old with a presumed cardiac-caused out-of-hospital cardiac arrest for which resuscitation was attempted. Patients were divided into 3 preselected age-groups: working-age patients 18 to 65 years of age (33.7%), early senior patients 66 to 80 years of age (41.5%), and late senior patients >80 years of age (24.8%). Characteristics in working-age patients, early senior patients, and late senior patients were as follows: witnessed arrest in 53.8%, 51.1%, and 52.1%; bystander cardiopulmonary resuscitation in 44.7%, 30.3%, and 23.4%; and prehospital shock from a defibrillator in 54.7%, 45.0%, and 33.8% (all P <0.05). Between 2001 and 2011, return of spontaneous circulation on hospital arrival increased: working-age patients, from 12.1% to 34.6%; early senior patients, from 6.4% to 21.5%; and late senior patients, from 4.0% to 15.0% (all P <0.001). Furthermore, 30-day survival increased: working-age patients, 5.8% to 22.0% ( P <0.001); and early senior patients, 2.7% to 8.4% ( P <0.001), whereas late senior patients experienced only a minor increase (1.5% to 2.0%; P =0.01). Overall, 3 of 9499 patients achieved 30-day survival if they met 2 criteria: had not achieved return of spontaneous circulation on hospital arrival and had not received a prehospital shock from a defibrillator. Conclusions— All age groups experienced a large temporal increase in survival on hospital arrival, but the increase in 30-day survival was most prominent in the young. With the use of only 2 criteria, it was possible to identify patients with a minimal chance of 30-day survival.

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“…[37][38][39][40][41] This decision rule provided the first scientifically validated evidence to guide prehospital providers as to when it is safe to terminate resuscitation. Similar rules to terminate in-hospital resuscitation do not exist, yet these prehospital derived rules may serve as a guideline for termination of the unwitnessed in-hospital cardiac arrest resuscitation.…”

Section: Termination Of Resuscitationmentioning

confidence: 99%

The impact of prehospital resuscitation research on in-hospital care

Mausz

Cheskes

2015

CJEM

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Since their introduction over 40 years ago, paramedics have been trained to deliver select advanced life support interventions in the community with the goal of reducing morbidity and mortality from cardiovascular disease and trauma. The ensuing decades witnessed a great deal of interest in paramedic care, with an exponential growth in prehospital resuscitation research. As part of the CJEM series on emergency medical services (EMS), we review recent prehospital research in out-of-hospital cardiac arrest and discuss how, in a novel departure from the origins of EMS, prehospital research is beginning to influence in-hospital care. We discuss emerging areas of study related to cardiopulmonary resuscitation (CPR) quality, therapeutic hypothermia, termination of resuscitation, and the use of end-tidal carbon dioxide measurement, as well as the subtle ripple effects that prehospital research is having on the broader understanding of the management of these critically ill patients. RÉSUMÉDepuis leur arrivée il y a plus d'une quarantaine d'années, les ambulanciers paramédicaux sont formés pour pratiquer certaines interventions de réanimation cardiorespiratoire (RCR) médicalisée dans la collectivité dans le but de réduire la morbidité et la mortalité liées aux maladies cardiovasculaires et aux traumas. Au cours des décennies suivantes, les soins paramédicaux ont suscité un vif intérêt, qui s'est accompagné d'une forte croissance de la recherche en réanimation préhospitalière. Dans le cadre de la série d'articles portant sur les services médi-caux d'urgence (SMU) dans le JCMU, il sera question de la recherche récente sur la prise en charge préhospitalière des arrêts cardiaques qui surviennent dans la collectivité ainsi que de l'influence que commence à avoir la recherche dans le domaine préhospitalier sur les soins hospitaliers, influence qui signe une nouvelle orientation par rapport au point de départ des SMU. L'article portera sur de nouveaux champs d'étude liés à la qualité de la RCR, à l'hypothermie thérapeutique, à l'arrêt des manoeuvres de réanimation et à l'utilisation de la mesure du gaz carbonique en fin d'expiration ainsi que sur les effets d'entraînement discrets que la recherche dans le domaine préhospitalier a sur la compréhension élargie du traitement des personnes gravement malades ou blessées.

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Derivation of a Termination‐of‐resuscitation Guideline for Emergency Medical Technicians Using Automated External Defibrillators

Cited by 57 publications

References 30 publications

Part 3: Ethics

Part 3: Ethics

Survival After Out-of-Hospital Cardiac Arrest in Relation to Age and Early Identification of Patients With Minimal Chance of Long-Term Survival

The impact of prehospital resuscitation research on in-hospital care

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