Open AccessThe Reliability of Modified Termination of Resuscitation Rules after Arrival at the Emergency Department
Author(s) -
Kuo CI,
Kuo CW,
Hsu SC,
Lin CC,
Weng YM
Publication year - 2014
Publication title -
hong kong journal of emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.145
H-Index - 12
eISSN - 2309-5407
pISSN - 1024-9079
DOI - 10.1177/102490791402100502
Subject(s) - medicine , emergency department , basic life support , resuscitation , confidence interval , emergency medicine , retrospective cohort study , clinical prediction rule , emergency medical services , advanced life support , cardiopulmonary resuscitation , pediatrics , psychiatry
Pre‐hospital termination of resuscitation (TOR) is not a usual practice in many cities. The current study aimed to examine the reliability of the modified basic life support (ED‐BLS) and advanced life support (ED‐ALS) rules for TOR after patient arrival at the emergency department (ED). Methods In this retrospective cohort study, adult non‐traumatic cardiac arrest patients who received pre‐hospital basic life support and defibrillator (BLS‐D) mode of service in Taoyuan County in northern Taiwan during the study period were assessed. Data were retrieved from web‐based registry records. Results Of the 1612 patients included, 40 (2.5%) achieved survival to discharge. The ED‐ALS rule showed higher specificity (ED‐ALS rule: 82.5% {95% confidence interval [CI]: 68.1‐91.3} vs. ED‐BLS rule: 50.0% {95%CI: 35.2‐64.8}) and positive predictive value (ED‐ALS rule: 99.0% {95% CI: 97.9‐99.5} vs. ED‐BLS rule: 98.6% {95%CI: 97.8‐99.1}) than the ED‐BLS rule in terms of predicting no survival to discharge after patient arrival at the ED. Among patients who fulfilled all criteria for the ED‐BLS and ED‐ALS rule, 20 (1.4%) and seven (1.0%) survived to discharge, respectively. Application of the ED‐BLS and ED‐ALS rules could have reduced further resuscitation efforts after arrival at the ED by 86.4% and 43.1%, respectively. Conclusion For non‐traumatic out‐of‐hospital cardiac arrest patients who receive BLS‐D service, the ED‐ALS rule has a higher specificity and PPV than the ED‐BLS rule to predict no survival to discharge after patient arrival at the ED. Using the ED‐ALS rule to terminate resuscitation after arrival at the ED should be prospectively validated. (Hong Kong j.emerg.med. 2014;21:283‐290)