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A comparison of the universal TOR Guideline to the absence of prehospital ROSC and duration of resuscitation in predicting futility from out-of-hospital cardiac arrest.

A comparison of the universal TOR Guideline to the absence of prehospital ROSC and duration of resuscitation in predicting futility from out-of-hospital cardiac arrest.

Authors :
Drennan IR
Case E
Verbeek PR
Reynolds JC
Goldberger ZD
Jasti J
Charleston M
Herren H
Idris AH
Leslie PR
Austin MA
Xiong Y
Schmicker RH
Morrison LJ
Source :
Resuscitation [Resuscitation] 2017 Feb; Vol. 111, pp. 96-102. Date of Electronic Publication: 2016 Dec 05.
Publication Year :
2017

Abstract

Introduction: The Universal Termination of Resuscitation (TOR) Guideline accurately identifies potential out-of-hospital cardiac arrest (OHCA) survivors. However, implementation is inconsistent with some Emergency Medical Service (EMS) agencies using absence of return of spontaneous circulation (ROSC) as sole criterion for termination.<br />Objective: To compare the performance of the Universal TOR Guideline with the single criterion of no prehospital ROSC. Second, to determine factors associated with survival for patients transported without a ROSC. Lastly, to compare the impact of time to ROSC as a marker of futility to the Universal TOR Guideline.<br />Design: Retrospective, observational cohort study.<br />Participants: Non-traumatic, adult (≥18 years) OHCA patients of presumed cardiac etiology treated by EMS providers.<br />Setting: ROC-PRIMED and ROC-Epistry post ROC-PRIMED databases between 2007 and 2011.<br />Outcomes: Primary outcome was survival to hospital discharge and the secondary outcome was functional survival. We used multivariable regression to evaluate factors associated with survival in patients transported without a ROSC.<br />Results: 36,543 treated OHCAs occurred of which 9467 (26%) were transported to hospital without a ROSC. Patients transported without a ROSC who met the Universal TOR Guideline for transport had a survival of 3.0% (95% CI 2.5-3.4%) compared to 0.7% (95% CI 0.4-0.9%) in patients who met the Universal TOR Guideline for termination. The Universal TOR Guideline identified 99% of survivors requiring continued resuscitation and transportation to hospital including early identification of survivors who sustained a ROSC after extended durations of CPR.<br />Conclusion: Using absence of ROSC as a sole predictor of futility misses potential survivors. The Universal TOR Guideline remains a strong predictor of survival.<br />Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the writing and content of the paper.<br /> (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1873-1570
Volume :
111
Database :
MEDLINE
Journal :
Resuscitation
Publication Type :
Academic Journal
Accession number :
27923115
Full Text :
https://doi.org/10.1016/j.resuscitation.2016.11.021