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

Summary: 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-Defibrillator (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 al. [BMJ 1995;311:49–51], Petrie [CJEM 2001;3:186–92] and Verbeek et al. [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. [Copyright &y& Elsevier]