Abstract 54: An Observational Analysis of Termination of Resuscitation in the Out-of-Hospital Setting
Introduction: Despite advancements in care, survival rates remain low after out-of-hospital cardiac arrests (OHCA). The Universal Termination of Resusciation (TOR) Guideline (Terminate if no shock delivered AND unwitnessed by EMS providers AND no return of spontaneous circulation (ROSC)) has been validated to accurately determine patients who can have resuscitation terminated in the prehospital setting. There remains, however, considerable variation in transportation practices among EMS providers including solely using absence of ROSC as evidence for futility.
Objective: To re-evaluate the survival rate of patients transported to hospital who met the Universal TOR Guideline for termination in the field and compare survival rates with the single criterion of no prehospital ROSC. Second to determine patient characteristics, prehospital and in-hospital factors associated with survival for patients who were transported without a prehospital ROSC.
Methods: Retrospective, observational cohort study using data from the ROC Epistry-Cardiac Arrest and ROC PRIMED databases between 2006 and 2011. All non-traumatic, adult (≥18 years) OHCA patients of presumed cardiac etiology were included. The primary outcome was survival to hospital discharge and the secondary outcome was functional survival (MRS≤3 or CPC≤2). We used multivariable regression analysis to evaluate factors associated with survival in patients transported without a ROSC.
Results: A total of 55,204 patients were analyzed in this study of which 32,324 (59%) were transported to hospital. Of those transported, the Universal TOR Guideline recommended termination of resuscitation in 7,129 (22%). Survival for these patients was 1.3% (95% CI 1.2-1.4%) and survival with good functional outcome was 0.11% (95% CI 0.07-0.15%). Patients that were transported but did not obtain a prehospital ROSC had a survival rate of 2.5%. Survival in these patients was associated with shockable rhythm (OR 3.47; 95% CI 2.40-5.02), EMS witnessed (OR 3.24; 95% CI 2.28-4.62), public location (OR 1.69; 95% CI 1.31-2.18) and bystander witnessed (OR 1.61; 95% CI 1.20-2.17).
Conclusion: Employing only ROSC as a predictor of futility is unfounded. The Universal TOR Guideline remains a strong predictor of survival.
- Cardiac arrest
- Cardiopulmonary resuscitation
- Emergency medical services (EMS)
- Return of spontaneous circulation (ROSC)
Author Disclosures: I.R. Drennan: None. E. Case: None. J.C. Reynolds: Research Grant; Significant; Michigan State University Clinical and Translational Sciences Institute. Other Research Support; Significant; Equipment from NeurOptics, Inc.. Z.D. Goldberger: None. H. Herren: None. M.A. Austin: None. J. Jasti: None. R. Schmicker: None. A. Idris: Research Grant; Significant; National Institute of Health, American Heart Association. M. Charleston: None. P.R. Leslie: None. P.R. Verbeek: None. L.J. Morrison: Research Grant; Significant; National Institutes of Health, Heart and Stroke Foundation of Canada, Canadian Institutes of Health Research. Other Research Support; Significant; National Institutes of Health.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.