Prehospital termination of resuscitation in cases of refractory out-of-hospital cardiac arrest

Context Identifying patients in the out- of- hospital setting who have no realistic hope of surviving an out- of- hospital cardiac arrest could enhance utilization of scarce health care resources. Objective To validate 2 out- of- hospital termination- of- resuscitation rules developed by the Ontario Prehospital Life Support ( OPALS) study group, one for use by responders providing basic life support ( BLS) and the other for those providing advanced life support ( ALS). Design, Setting, and Patients Retrospective cohort study using surveillance data prospectively submitted by emergency medical systems and hospitals in 8 US cities to the Cardiac Arrest Registry to Enhance Survival ( CARES) between October 1, 2005, and April 30, 2008. Case patients were 7235 adults with out- of- hospital cardiac arrest; of these, 5505 met inclusion criteria. Main Outcome Measures Specificity and positive predictive value of each termination-of-resuscitation rule for identifying patients who likely will not survive to hospital discharge. Results The overall rate of survival to hospital discharge was 7.1% ( n= 392). Of 2592 patients ( 47.1%) who met BLS criteria for termination of resuscitation efforts, only 5( 0.2%) patients survived to hospital discharge. Of 1192 patients ( 21.7%) who met ALS criteria, none survived to hospital discharge. The BLS rule had a specificity of 0.987( 95% confidence interval [ CI], 0.970- 0.996) and a positive predictive value of 0.998( 95% CI, 0.996- 0.999) for predicting lack of survival. The ALS rule had a specificity of 1.000( 95% CI, 0.991- 1.000) and positive predictive value of 1.000( 95% CI, 0.997- 1.000) for predicting lack of survival. Conclusion In this validation study, the BLS and ALS termination- of- resuscitation rules performed well in identifying patients with out- of- hospital cardiac arrest who have little or no chance of survival.