Abstract P137: Basic Life Support Termination of Resuscitation Guideline Implementation Trial (TORIT)
Objective: This implementation study objective was to evaluate the transport rate of out-of-hospital (OHCA) patients when the universal Termination of Resuscitation (TOR) guideline was applied and followed; termination recommended when no return of spontaneous circulation, and no shocks delivered, and the arrest was not witnessed by prehospital providers. Secondary aims were to report erroneous guideline application and the comfort of the paramedic and delegating physician.
Methods: This trial was conducted from January 2006 to September 2008. Adult OHCA patients of presumed cardiac etiology and treated by defibrillator only trained paramedics were eligible. After applying the guideline the provider contacted the delegating physician when termination was recommended and both provider and physician completed a data collection form indicating their comfort on a 5 point Likert scale.
Results: During the study there were 2421 OHCA and 954 patients were eligible for TOR guideline application. Of these, the TOR guideline was followed in 756 cases resulting in 388 terminations and 368 transports. The two groups were similar in age, gender and response time intervals. There were no violations in guideline application. In 198 cases where the TOR guideline was not followed, paramedics cited 241 reasons: Family distress (56), short time intervals (54), patient age (13) and public venue (10) accounted for 55%. Paramedic discomfort was cited 28 times (11%). In 14 cases they were unable to establish telephone contact. In 23 cases the guideline recommended termination and the physician chose to transport (2.4%). All of these 198 TOR eligible patients died inhospital. When the TOR guideline was applied the transport rate was 46.7% which is significantly different than the transport rate of 100% when the TOR guideline was not applied (p<0.001). Both providers and physicians were very comfortable (median (IQR) of 5 (4,5); p<0.001).
Conclusions: The transport rate is significantly reduced when the universal TOR guideline was followed. It was applied by providers without error. In <3% of cases, physicians transported when the guideline suggested termination and all of these patients died. The providers and physicians were equally comfortable following the guideline.