Comparison of termination-of-resuscitation guidelines for out-of-hospital cardiac arrest in Singapore EMS

被引:30
作者
Ong, Marcus Eng Hock [1 ]
Tan, Eng Hoe [2 ]
Ng, Faith Suan Peng [3 ]
Yap, Susan [1 ]
Panchatingham, Anushia [3 ]
Leong, Benjamin Sieu-Hon [4 ]
Ong, Victor Yeok Kein [5 ]
Tiah, Ling [6 ]
Lim, Swee Han [1 ]
Venkataraman, Anantharaman [1 ]
机构
[1] Singapore Gen Hosp, Dept Emergency Med, Singapore 169608, Singapore
[2] Singapore Civil Def Force, Dept Med, Singapore, Singapore
[3] Singapore Hlth Serv, Clin Trials & Epidemiol Res Unit, Singapore, Singapore
[4] Natl Univ Singapore Hosp, Dept Emergency Med, Singapore, Singapore
[5] Alexandra Hosp, Dept Emergency Med, Singapore, Singapore
[6] Changi Gen Hosp, Dept Emergency Med, Singapore, Singapore
基金
英国医学研究理事会;
关键词
emergency medical services; cardiopulmonary resuscitation; Basic Life Support (BLS); ethics; termination of resuscitation;
D O I
10.1016/j.resuscitation.2007.04.013
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Context: Termination of resuscitation (TOR) in the field for out-of-hospital cardiac arrest (OHCA) can reduce unnecessary transport to hospital and increase availability of resources for other patients. Objectives: To compare the performance of three TOR guidelines for Basic Life Support-Defibrittator (BLS-D) providers when applied to cardiac arrest patients in the Cardiac Arrest and Resuscitation Epidemiology (CARE) study. Design: This prospective cohort study involved all OHCA patients attended by BLS-D providers in a large urban center. The data analyses were conducted secondarily on these prospectively collected data. Three TOR guidelines proposed by Marsden et at. [BMJ 1995;311:49-51], Petrie [CJEM 2001;3:186-92] and Verbeek et at. [Acad Emerg Med 2002;9:671-8] were applied to show the relationship between the guidelines and actual survival. Results: From 1 October 2001 to 14 October 2004, 2269 patients were enrolled into the study. Thirty-two (1.4%) survived to hospital discharge. For the 3 TOR guidelines, sensitivity was 93.8% (95%CI = 79.9-98.3) (Petrie), 81.3% (95%CI = 64.7-91. 1) (Verbeek) and 90.6% (95%CI = 75.8-96.8) (Marsden). Negative predictive value was 99.7% (95%CI = 99.0-100.0) (Petrie), 99.6% (95%CI = 99.2-99.8) (Verbeek) and 99.8% (95%CI = 99.4-99.9) (Marsden). Application of these guidelines would have resulted in transport of 68.4% (Petrie), 31.3% (Verbeek) and 36.1 % (Marsden) of cases. The Petrie guidelines would have recommended TOR in two patients who eventually survived. Similarly TOR was recommended in six patients for Verbeek and three patients for Marsden who eventually survived. Conclusion: We found all three TOR guidelines to have high sensitivity and negative predictive value. However the specificity and transport rates varied greatly. Application of any TOR guidelines may be affected by local EMS and population factors which should be considered in any policy decision. (C) 2007 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:244 / 251
页数:8
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