Factors for modifying the termination of resuscitation rule in out-of-hospital cardiac arrest

Yoon, Jae Chol; Kim, Youn-Jung; Kim, Won Young; Jin, Young Ho; Lee, Sung‐Woo; Song, Kyoung Jun; Shin, Sang Do; Hwang, Sung Oh

doi:10.1016/j.ahj.2019.04.003

Cited by 21 publications

(48 citation statements)

References 22 publications

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“…Based on this collective data, we determined whether the patients met the existing TOR guidelines and quali ed to be enrolled in this study. In South Korea, EMS personnel cannot terminate resuscitation unless OHCA patients show obvious signs of death [7,11];therefore, all EMS-treated OHCA patients should be transported to the hospitals.Notably, these personnel use manual de brillators and analyze electrocardiograms(ECGs) prior tothe patients' arrival at the hospital.…”

Section: Study Design and Variablesmentioning

confidence: 99%

“…Secondary outcome measures included external validation of previously researched TOR rules ( Table 1). We delineated OHCA patients who met all the TOR criteria and calculated sensitivity, speci city, false positive ratios (FPR), false negative ratios, positive predictive values (PPV), negative predictive values (NPV), and their respective 95% con dence intervals (CI) to identify patients with a risk of poor survival [7,8,11,13,14]. Logistic regressions were performed for patients who met the criteria of the previous TOR rules.…”

Section: Main Outcome Measuresmentioning

confidence: 99%

“…Fortunately, recent cardiopulmonary resuscitation (CPR) guidelineswere changed, recommendingthat all healthcare providers assess the safety of the scene and wear higher levels of PPE for protection against infectious airborne dropletsand detailing the criteria for the basic life support termination of resuscitation (BLS-TOR) rule. These guidelines stated that before terminating resuscitative efforts, the healthcare workers must check that 1) the arrest was not witnessed byemergency medical service (EMS) personnel or a rst responder,2)ROSC was not observed prior to the patient being transported to the emergency medical centre (EMC), and 3) no electrical shocks were delivered [7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…We applied the rules that were typically selected depending on the country or region where the derivation and validation phaseswere conducted.These included the(1) International BLS and advanced life support (ALS) rules derived and validated in the United States and Europe [8], (2) Goto and KANTO-SOS rules developed in Japan and Asian countries [13,14], and (3) Korean OHCA registry-based TOR models,Korean Cardiac Arrest Research Consortium (KoCARC) TOR rules, and two new TOR models, whichwere used in our previous studies [7,11].…”

Section: Introductionmentioning

confidence: 99%

“…In Daegu metropolitan city, the number of patients with COVID-19 increased rapidlyat the community level fromFebruary 18, 2020, in response to the pandemic outbreak in South Korea.During its 7-week peak, we resuscitated 184 OHCA patients at six EMCs. This was the rst study to determine the e cacy of these TOR guidelinesfor an emerging infectious disease [7,11,12].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Investigations External Validation of Multimodal Termination of Resuscitation Rules for Out-of-hospital Cardiac Arrest Patients in the Covid-19 Era

Jung

Lee

Cho

et al. 2020

Preprint

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Background:Futile resuscitation for out-of-hospital cardiac arrest (OHCA) patients in the COVID-19 era can lead to risk of disease transmission and unnecessary transport. Various existing basic or advanced life support (BLS or ALS) rules for termination of resuscitation (TOR)have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era.Methods: A multicenter observational study was performed using the WinCOVID-19 Daegu registry data collected from 18 February to 31March 2020. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity, specificity, false positive ratio (FPR), and positive predictive value (PPV) of each TOR rule were evaluated. Results: Of the 184 OHCA patients, 170 patients,who showed cardiac arrest of presumed cardiac etiology, were enrolled. TOR was recommended for 122 patientsbased on the international BLS-TOR rule, which showed 85% specificity, 74% sensitivity, 0.8% FPR, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPR (upper limit of 95% confidence interval<5%) and PPV (>99%) criteria, only the KoCARCTOR rule I, which included a combination ofthree factors including not being witnessed by emergency medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock delivery or ROSC, was found to be superiorto all other TOR rules. Conclusion: Among the previous nine BLS and ALS TOR rules, KoCARCTOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide.Trial registration: Not applicable

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Section: Study Design and Variablesmentioning

confidence: 99%

Section: Main Outcome Measuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical Investigations External Validation of Multimodal Termination of Resuscitation Rules for Out-of-hospital Cardiac Arrest Patients in the Covid-19 Era

Jung

Lee

Cho

et al. 2020

Preprint

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Termination of Resuscitation Rules and Survival Among Patients With Out-of-Hospital Cardiac Arrest

Smyth,

Gunson,

Coppola

et al. 2024

JAMA Netw Open

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ImportanceTermination of resuscitation (TOR) rules may help guide prehospital decisions to stop resuscitation, with potential effects on patient outcomes and health resource use. Rules with high sensitivity risk increasing inappropriate transport of nonsurvivors, while rules without excellent specificity risk missed survivors. Further examination of the performance of TOR rules in estimating survival of out-of-hospital cardiac arrest (OHCA) is needed.ObjectiveTo determine whether TOR rules can accurately identify patients who will not survive an OHCA.Data SourcesFor this systematic review and meta-analysis, the MEDLINE, Embase, CINAHL, Cochrane Library, and Web of Science databases were searched from database inception up to January 11, 2024. There were no restrictions on language, publication date, or time frame of the study.Study SelectionTwo reviewers independently screened records, first by title and abstract and then by full text. Randomized clinical trials, case-control studies, cohort studies, cross-sectional studies, retrospective analyses, and modeling studies were included. Systematic reviews and meta-analyses were reviewed to identify primary studies. Studies predicting outcomes other than death, in-hospital studies, animal studies, and non–peer-reviewed studies were excluded.Data Extraction and SynthesisData were extracted by one reviewer and checked by a second. Two reviewers assessed risk of bias using the Revised Quality Assessment Tool for Diagnostic Accuracy Studies. Cochrane Screening and Diagnostic Tests Methods Group recommendations were followed when conducting a bivariate random-effects meta-analysis. This review followed the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) statement and is registered with the International Prospective Register of Systematic Reviews (CRD42019131010).Main Outcomes and MeasuresSensitivity and specificity tables with 95% CIs and bivariate summary receiver operating characteristic (SROC) curves were produced. Estimates of effects at different prevalence levels were calculated. These estimates were used to evaluate the practical implications of TOR rule use at different prevalence levels.ResultsThis review included 43 nonrandomized studies published between 1993 and 2023, addressing 29 TOR rules and involving 1 125 587 cases. Fifteen studies reported the derivation of 20 TOR rules. Thirty-three studies reported external data validations of 17 TOR rules. Seven TOR rules had data to facilitate meta-analysis. One clinical study was identified. The universal termination of resuscitation rule had the best performance, with pooled sensitivity of 0.62 (95% CI, 0.54-0.71), pooled specificity of 0.88 (95% CI, 0.82-0.94), and a diagnostic odds ratio of 20.45 (95% CI, 13.15-31.83).Conclusions and RelevanceIn this review, there was insufficient robust evidence to support widespread implementation of TOR rules in clinical practice. These findings suggest that adoption of TOR rules may lead to missed survivors and increased resource utilization.

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A Simple Scoring System for Identifying Favorable Neurologic Outcomes Among Out-of-Hospital Cardiac Arrest Patients With Asystole

Park,

Kim,

Kwon

et al. 2024

Annals of Emergency Medicine

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Factors for modifying the termination of resuscitation rule in out-of-hospital cardiac arrest

Cited by 21 publications

References 22 publications

Clinical Investigations External Validation of Multimodal Termination of Resuscitation Rules for Out-of-hospital Cardiac Arrest Patients in the Covid-19 Era

Clinical Investigations External Validation of Multimodal Termination of Resuscitation Rules for Out-of-hospital Cardiac Arrest Patients in the Covid-19 Era

Termination of Resuscitation Rules and Survival Among Patients With Out-of-Hospital Cardiac Arrest

A Simple Scoring System for Identifying Favorable Neurologic Outcomes Among Out-of-Hospital Cardiac Arrest Patients With Asystole

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