The reliability of modified termination of resuscitation rules after arrival at the emergency department

Abstract

Introduction: 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 nontraumatic 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.