Diagnostic performance of the basic and advanced life support termination of resuscitation rules: A systematic review and diagnostic meta-analysis

Nas, Joris; Kleinnibbelink, Geert; Hannink, Gerjon; Navarese, Eliano Pio; Royen, Niels van; Boer, Menko‐Jan de; Wik, Lars; Bonnes, Judith L.; Brouwer, Marc A.

doi:10.1016/j.resuscitation.2019.12.016

Cited by 26 publications

(12 citation statements)

References 59 publications

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“…In Taiwan, all OHCA patients should be transported to the hospital except those with apparent death, existing DNAR orders or families who declined transportation in consideration of patient status. Since the TOR in the field was legally permitted in some western regions instead of non-western regions, a few of those individuals with cessation of resuscitation would probably survive when transported [ 30 , 31 ]. As a result, the predictive performance of the TOR rules in some western regions may be overestimated.…”

Section: Discussionmentioning

confidence: 99%

Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols

et al. 2022

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Background Resuscitation guidance has advanced; however, the predictive performance of the termination of resuscitation (TOR) rule has not been validated for different resuscitation protocols published by the American Heart Association (AHA). Methods A retrospective study validating the basic life support (BLS) and advanced life support (ALS) TOR rules was conducted using an Utstein-style database in Tainan city, Taiwan. Adult patients with nontraumatic out-of-hospital cardiac arrests from January 1, 2015, to December 31, 2015, (using the AHA 2010 resuscitation protocol) and from January 1, 2020, to December 31, 2020, (using the AHA 2015 resuscitation protocol) were included. The characteristics of rule performance were calculated, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value. Results Among 1260 eligible OHCA patients in 2015, 757 met the BLS TOR rule and 124 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 61.1% and 99.0%, respectively, for the BLS TOR rule and 93.8% and 99.2%, respectively, for the ALS TOR rule. A total of 970 OHCA patients were enrolled in 2020, of whom 438 met the BLS TOR rule and 104 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 85.7% and 100%, respectively, for the BLS TOR rule and 99.5% and 100%, respectively, for the ALS TOR rule. Conclusions Both the BLS and ALS TOR rules performed better when using the 2015 AHA resuscitation protocols compared to the 2010 protocols, with increased PPVs and decreased false-positive rates in predicting survival to discharge and good neurological outcomes at discharge. The BLS and ALS TOR rules can perform differently while the resuscitation protocols are updated. As the concepts and practices of resuscitation progress, the BLS and ALS TOR rules should be evaluated and validated accordingly.

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Section: Discussionmentioning

confidence: 99%

Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols

et al. 2022

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Section: Discussionmentioning

confidence: 99%

“…In Western countries, out-of-hospital termination-of-resuscitation rules perform well, with proportions of cardiac arrest survivors recommended for termination (i.e., miss rates) of <1% [ 43 , 44 ]. However, miss rates may exceed 6% in countries with lower proportions of in-field defibrillation attempts and shorter in-field resuscitation before patient transportation [ 44 ]. Furthermore, the application of termination-of-resuscitation protocols may vary widely at the country level (according to legal support) [ 6 , 44 ], regional healthcare system level (depending on the local frequency of witnessed arrest and bystander CPR) [ 45 ], emergency medical service (EMS) or hospital level (according to service-specific or institution-specific resuscitation policies) [ 44 , 46 ] and healthcare professional level (according to pertinent knowledge/expertise, confidence and right/responsibility to decide, possible fear of litigation and personal views) [ 6 , 47 , 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

Evolution of European Resuscitation and End-of-Life Practices from 2015 to 2019: A Survey-Based Comparative Evaluation

Mentzelopoulos

Couper

Raffay

et al. 2022

JCM

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Background: In concordance with the results of large, observational studies, a 2015 European survey suggested variation in resuscitation/end-of-life practices and emergency care organization across 31 countries. The current survey-based study aimed to comparatively assess the evolution of practices from 2015 to 2019, especially in countries with “low” (i.e., average or lower) 2015 questionnaire domain scores. Methods: The 2015 questionnaire with additional consensus-based questions was used. The 2019 questionnaire covered practices/decisions related to end-of-life care (domain A); determinants of access to resuscitation/post-resuscitation care (domain B); diagnosis of death/organ donation (domain C); and emergency care organization (domain D). Responses from 25 countries were analyzed. Positive or negative responses were graded by 1 or 0, respectively. Domain scores were calculated by summation of practice-specific response grades. Results: Domain A and B scores for 2015 and 2019 were similar. Domain C score decreased by 1 point [95% confidence interval (CI): 1–3; p = 0.02]. Domain D score increased by 2.6 points (95% CI: 0.2–5.0; p = 0.035); this improvement was driven by countries with “low” 2015 domain D scores. In countries with “low” 2015 domain A scores, domain A score increased by 5.5 points (95% CI: 0.4–10.6; p = 0.047). Conclusions: In 2019, improvements in emergency care organization and an increasing frequency of end-of-life practices were observed primarily in countries with previously “low” scores in the corresponding domains of the 2015 questionnaire.

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“…A previous systematic review and meta-analysis on termination of resuscitation also highlighted clinical variation in the diagnostic performance of criteria. For this reason, local criteria validation was recommended to prevent the termination of resuscitation in potential survivors (27).…”

Section: Discussionmentioning

confidence: 99%

The Regional Resuscitation Guidelines for Pulseless Electrical Activity in Emergency Medical Services in the United Kingdom: A Systematic Review

Coppola

Smyth²,

Black³

et al. 2021

Australasian Journal of Paramedicine

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Background Pulseless electrical activity (PEA) is managed in accordance with international and national guidelines. These guidelines are not fully evidenced, resulting in emergency medical services in the United Kingdom amending guidelines to support paramedics when making resuscitation decisions. This review examined the local guidelines of services to identify the local clinical management of PEA, summarise the available evidence and prioritise future research. Methods The review was conducted according to the Joanna Briggs Institute systematic review of text and opinion. The review included locally amended guidelines and cited evidence sources for the management of PEA. A three-step search strategy was applied. Textual data was extracted to form conclusions which were categorised into similar meaning and developed into synthesised findings. Results Twenty-two documents met the inclusion criteria; Twenty-seven conclusions were extracted and analysed to generate 10 categories, forming three synthesised themes: the variability in the clinical management of PEA between ambulance services; the early identification of reversible causes and appropriate treatment options to increase survivability; and the consensus for further research. Conclusion This review identified variability in the clinical management of PEA; the autonomy of paramedics, which patients to transport to hospital and the factors applied to inform resuscitation decisions. A summary of the evidence in support of the local guidelines found that the early identification and treatment to reverse the cause of PEA was important to patient survival, however, this was acknowledged as complex and challenging to achieve. There was a consensus to improve patient outcomes using prognostic research.

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Diagnostic performance of the basic and advanced life support termination of resuscitation rules: A systematic review and diagnostic meta-analysis

Cited by 26 publications

References 59 publications

Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols

Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols

Evolution of European Resuscitation and End-of-Life Practices from 2015 to 2019: A Survey-Based Comparative Evaluation

The Regional Resuscitation Guidelines for Pulseless Electrical Activity in Emergency Medical Services in the United Kingdom: A Systematic Review

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