Abstract 49: Performance of North American Prehospital Termination of Resuscitation Rules in Osaka, Japan.
Introduction: In Japan, EMS guidelines require that all patients with out-of-hospital cardiac arrest (OHCA) be transported to a hospital regardless of the success or failure of prehospital resuscitation efforts. In an attempt to better utilize health care resources, Basic Life Support (BLS) and Advanced Life Support (ALS) prehospital termination of resuscitation (TOR) rules have been developed, validated and implemented in North America.
Purpose: The aim of this study was to assess the performance and impact of these BLS and ALS TOR rules in Osaka, Japan.
Materials and methods: This was a retrospective cohort analysis of all persons aged 18 years or older who suffered OHCA of presumed cardiac etiology in Osaka Prefecture, Japan from January 2005 through December 2008. All data were prospectively collected an Utstein-style database. Primary outcome measure was one month neurologically favorable survival (CPC ≤ 2). Cases were dichotomized on the basis of whether they met the criteria for the BLS TOR rule (OHCA not witnessed by EMS personnel and no prehospital AED use or return of spontaneous circulation) or the ALS TOR rule (BLS rule criteria plus OHCA not witnessed by a bystander and no bystander CPR). We calculated the specificity and positive predictive value of each TOR rule for identifying patients without one-month survival with favorable neurological outcome.
Results: Of 14,921 cardiac arrests of presumed cardiac etiology, 607 cases (4.1%) had neurologically favorable survival. Of 11,038 cases (74%) who met BLS criteria for TOR efforts, only 26 cases (0.2%) survived to neurologically favorable survival. Of 4,752 (32%) who met the ALS criteria for TOR efforts, only 10 cases (0.2%) survived to neurologically favorable survival.
Conclusion: The North American BLS and ALS TOR rules both performed well in Osaka with misclassification rates of 0.2%. Implementation of these guidelines into current resuscitation practices in Japan deserves further consideration.
- © 2010 by American Heart Association, Inc.