Validation of a universal prehospital termination of resuscitation clinical prediction rule for advanced and basic life support providers

Morrison, Laurie J.; Verbeek, P. Richard; Zhan, Cathy; Kiss, Alex; Allan, Katherine S.

doi:10.1016/j.resuscitation.2008.11.014

Cited by 139 publications

(96 citation statements)

References 20 publications

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“…The 2015 American Heart Association (AHA) as well as the European Resuscitation Council (ERC) guidelines for cardiopulmonary resuscitation (CPR) describe basic life support (BLS) and advanced life support (ALS) rules for termination of resuscitation (TOR) (2). Several studies have evaluated the generalizability of the TOR rules in BLS and ALS emergency medical services (EMS) systems ( Table 1) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The BLS TOR rule suggests that resuscitative efforts may be aborted in patients whose arrest was not witnessed by EMS, in whom return of spontaneous circulation (ROSC) is not achieved in the field and when no shocks are delivered ( Table 1).…”

mentioning

confidence: 99%

Should we resuscitate or not—that is the question!

Bernhard¹,

Becker

Hossfeld

2016

J. Thorac. Dis.

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mentioning

confidence: 99%

Should we resuscitate or not—that is the question!

Bernhard¹,

Becker

Hossfeld

2016

J. Thorac. Dis.

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“…7 Compared to cardiac etiology OHCA patients, drowning patients in Ontario were more often transported to hospital, which is most likely attributable to the fact that drownings are excluded from the application of termination of resuscitation guidelines. 20,21 Drowning patients were more often admitted to hospital alive compared to cardiac OHCA patients, although there was no difference in survival to hospital discharge. This increase in short-term survival could be explained by the relatively public nature of drownings, which predominantly occur outside or in a shared space and are thus more likely to attract a crowd response.…”

Section: Discussionmentioning

confidence: 91%

“…Treated cardiac arrests of presumed cardiac etiology were eligible for prehospital termination of resuscitation after paramedics consulted with an online medical director or base hospital physician based on a previously validated tool for any unwitnessed arrest, with no defibrillator shocks delivered and no return of spontaneous circulation. 20,21 The resuscitation of drowning OHCA patients was terminated only after direction from the online medical director or base hospital physician as OHCA attributed to drowning falls outside the termination of resuscitation protocol.…”

Section: Setting and Patient Selectionmentioning

confidence: 99%

Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada

Buick

Lin

Rac

et al. 2014

CJEM

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Introduction: Drowning is a major public health concern, yet little is known about the characteristics of drowning patients. The objectives of this study were to describe the demographic and clinical characteristics of out-of-hospital cardiac arrest (OHCA) attributed to drowning in Ontario and to compare the characteristics of OHCA attributed to drowning to those of presumed cardiac etiology. Methods: A retrospective, observational study was carried out of consecutive OHCA patients of drowning etiology in Ontario between August 2006 and July 2011. Bivariate analysis was used to evaluate differences between drowning and presumed cardiac etiologies. Results: A total of 31,763 OHCA patients were identified, and 132 (0.42%) were attributed to drowning. Emergency medical services treated 98 patients, whereas the remaining 34 met the criteria for legislative death. Overall, 5.1% of drowning patients survived to hospital discharge. When compared to patients of presumed cardiac etiology, drowning patients were younger and their arrest was more likely to be unwitnessed, present with a nonshockable initial rhythm, occur in a public location, and receive bystander cardiopulmonary resuscitation (CPR). A nonsignificant trend was noted for drowning cases to more frequently have a public access AED applied. There were no significant differences in the gender ratio or paramedic response times. Drowning patients were more likely to be transported to hospital but had a trend to be less likely to arrive with a return of spontaneous circulation. They were also more likely to be admitted to hospital but had no difference in survival to hospital discharge. Conclusions: Significant differences exist between OHCA of drowning and presumed cardiac etiologies. Most drownings are unwitnessed, occur in public locations, and present with nonshockable initial rhythms, suggesting that treatment should focus on bystander CPR. Future initiatives should focus on strategies to improve supervision in targeted locations and greater emphasis on bystander-initiated CPR, both of which may reduce drowning mortality.

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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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Validation of a universal prehospital termination of resuscitation clinical prediction rule for advanced and basic life support providers

Cited by 139 publications

References 20 publications

Should we resuscitate or not—that is the question!

Should we resuscitate or not—that is the question!

Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada

The impact of prehospital resuscitation research on in-hospital care

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