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Out-of-hospital cardiac arrest termination of resuscitation with ongoing CPR : An observational study

Yates, E. J.; Schmidbauer, S. LU ; Smyth, A. M.; Ward, M.; Dorrian, S.; Siriwardena, A. N.; Friberg, H. LU and Perkins, G. D. (2018) In Resuscitation 130. p.21-27
Abstract

Introduction: Termination of resuscitation guidelines for out-of-hospital cardiac arrest can identify patients in whom continuing resuscitation has little chance of success. This study examined the outcomes of patients transferred to hospital with ongoing CPR. It assessed outcomes for those who would have met the universal prehospital termination of resuscitation criteria (no shocks administered, unwitnessed by emergency medical services, no return of spontaneous circulation). Methods: A retrospective cohort study of consecutive adult patients who were transported to hospital with ongoing CPR was conducted at three hospitals in the West Midlands, UK between September 2016 and November 2017. Patient characteristics, interventions and... (More)

Introduction: Termination of resuscitation guidelines for out-of-hospital cardiac arrest can identify patients in whom continuing resuscitation has little chance of success. This study examined the outcomes of patients transferred to hospital with ongoing CPR. It assessed outcomes for those who would have met the universal prehospital termination of resuscitation criteria (no shocks administered, unwitnessed by emergency medical services, no return of spontaneous circulation). Methods: A retrospective cohort study of consecutive adult patients who were transported to hospital with ongoing CPR was conducted at three hospitals in the West Midlands, UK between September 2016 and November 2017. Patient characteristics, interventions and response to treatment (ROSC, survival to discharge) were identified. Results: 227 (median age 69 years, 67.8% male) patients were identified. 89 (39.2%) met the universal prehospital termination of resuscitation criteria. Seven (3.1%) were identified with a potentially reversible cause of cardiac arrest. After hospital arrival, patients received few specialist interventions that were not available in the prehospital setting. Most (n = 210, 92.5%) died in the emergency department. 17 were admitted (14 to intensive care), of which 3 (1.3%) survived to hospital discharge. There were no survivors (0%) in those who met the criteria for universal prehospital termination of resuscitation. Conclusion: Overall survival amongst patients transported to hospital with ongoing CPR was very poor. Application of the universal prehospital termination of resuscitation rule, in patients without obvious reversible causes of cardiac arrest, would have allowed resuscitation to have been discontinued at the scene for 39.2% of patients who did not survive.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Cardiopulmonary resuscitation, CPR, Decision support techniques, OHCA, Ongoing CPR, observational, Out-of-hospital cardiac arrest, Return of spontaneous circulation, ROSC, Survival to discharge, Termination of resuscitation, TOR, UK, Universal prehospital termination of resuscitation rule, West Midlands
in
Resuscitation
volume
130
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:85049115003
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2018.06.021
language
English
LU publication?
yes
id
1820d219-3ad8-4ee6-8718-9fb17d259a58
date added to LUP
2018-07-09 11:34:26
date last changed
2018-07-10 03:00:05
@article{1820d219-3ad8-4ee6-8718-9fb17d259a58,
  abstract     = {<p>Introduction: Termination of resuscitation guidelines for out-of-hospital cardiac arrest can identify patients in whom continuing resuscitation has little chance of success. This study examined the outcomes of patients transferred to hospital with ongoing CPR. It assessed outcomes for those who would have met the universal prehospital termination of resuscitation criteria (no shocks administered, unwitnessed by emergency medical services, no return of spontaneous circulation). Methods: A retrospective cohort study of consecutive adult patients who were transported to hospital with ongoing CPR was conducted at three hospitals in the West Midlands, UK between September 2016 and November 2017. Patient characteristics, interventions and response to treatment (ROSC, survival to discharge) were identified. Results: 227 (median age 69 years, 67.8% male) patients were identified. 89 (39.2%) met the universal prehospital termination of resuscitation criteria. Seven (3.1%) were identified with a potentially reversible cause of cardiac arrest. After hospital arrival, patients received few specialist interventions that were not available in the prehospital setting. Most (n = 210, 92.5%) died in the emergency department. 17 were admitted (14 to intensive care), of which 3 (1.3%) survived to hospital discharge. There were no survivors (0%) in those who met the criteria for universal prehospital termination of resuscitation. Conclusion: Overall survival amongst patients transported to hospital with ongoing CPR was very poor. Application of the universal prehospital termination of resuscitation rule, in patients without obvious reversible causes of cardiac arrest, would have allowed resuscitation to have been discontinued at the scene for 39.2% of patients who did not survive.</p>},
  author       = {Yates, E. J. and Schmidbauer, S. and Smyth, A. M. and Ward, M. and Dorrian, S. and Siriwardena, A. N. and Friberg, H. and Perkins, G. D.},
  issn         = {0300-9572},
  keyword      = {Cardiac arrest,Cardiopulmonary resuscitation,CPR,Decision support techniques,OHCA,Ongoing CPR, observational,Out-of-hospital cardiac arrest,Return of spontaneous circulation,ROSC,Survival to discharge,Termination of resuscitation,TOR,UK,Universal prehospital termination of resuscitation rule,West Midlands},
  language     = {eng},
  month        = {09},
  pages        = {21--27},
  publisher    = {Elsevier},
  series       = {Resuscitation},
  title        = {Out-of-hospital cardiac arrest termination of resuscitation with ongoing CPR : An observational study},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2018.06.021},
  volume       = {130},
  year         = {2018},
}