Termination of resuscitation in out-of-hospital cardiac arrest in women and men: An ESCAPE-NET project

Smits, Robin L A; Sødergren, S.T.F.; Schuppen, Hans van; Folke, Fredrik; Ringh, Mattias; Jonsson, Martin; Motazedi, E.; Valkengoed, Irene G. M. van; Tan, Hanno L.

doi:10.1016/j.resuscitation.2023.109721

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…First-pass title and abstract screening yielded 131 potentially eligible studies. After the second-pass full-text screening, 43 studies remained (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…We identified very low-certainty evidence (downgraded for risk of bias, inconsistency, imprecision, indirectness, and publication bias) from 33 observational studies involving 927 534 cases. These studies reported external data validations of 17 TOR rules.…”

Section: Resultsmentioning

confidence: 99%

“…First-pass title and abstract screening yielded 131 potentially eligible studies. After the second-pass full-text screening, 43 studies 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 remained ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

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Termination of Resuscitation Rules and Survival Among Patients With Out-of-Hospital Cardiac Arrest

Smyth,

Gunson,

Coppola

et al. 2024

JAMA Netw Open

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ImportanceTermination of resuscitation (TOR) rules may help guide prehospital decisions to stop resuscitation, with potential effects on patient outcomes and health resource use. Rules with high sensitivity risk increasing inappropriate transport of nonsurvivors, while rules without excellent specificity risk missed survivors. Further examination of the performance of TOR rules in estimating survival of out-of-hospital cardiac arrest (OHCA) is needed.ObjectiveTo determine whether TOR rules can accurately identify patients who will not survive an OHCA.Data SourcesFor this systematic review and meta-analysis, the MEDLINE, Embase, CINAHL, Cochrane Library, and Web of Science databases were searched from database inception up to January 11, 2024. There were no restrictions on language, publication date, or time frame of the study.Study SelectionTwo reviewers independently screened records, first by title and abstract and then by full text. Randomized clinical trials, case-control studies, cohort studies, cross-sectional studies, retrospective analyses, and modeling studies were included. Systematic reviews and meta-analyses were reviewed to identify primary studies. Studies predicting outcomes other than death, in-hospital studies, animal studies, and non–peer-reviewed studies were excluded.Data Extraction and SynthesisData were extracted by one reviewer and checked by a second. Two reviewers assessed risk of bias using the Revised Quality Assessment Tool for Diagnostic Accuracy Studies. Cochrane Screening and Diagnostic Tests Methods Group recommendations were followed when conducting a bivariate random-effects meta-analysis. This review followed the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) statement and is registered with the International Prospective Register of Systematic Reviews (CRD42019131010).Main Outcomes and MeasuresSensitivity and specificity tables with 95% CIs and bivariate summary receiver operating characteristic (SROC) curves were produced. Estimates of effects at different prevalence levels were calculated. These estimates were used to evaluate the practical implications of TOR rule use at different prevalence levels.ResultsThis review included 43 nonrandomized studies published between 1993 and 2023, addressing 29 TOR rules and involving 1 125 587 cases. Fifteen studies reported the derivation of 20 TOR rules. Thirty-three studies reported external data validations of 17 TOR rules. Seven TOR rules had data to facilitate meta-analysis. One clinical study was identified. The universal termination of resuscitation rule had the best performance, with pooled sensitivity of 0.62 (95% CI, 0.54-0.71), pooled specificity of 0.88 (95% CI, 0.82-0.94), and a diagnostic odds ratio of 20.45 (95% CI, 13.15-31.83).Conclusions and RelevanceIn this review, there was insufficient robust evidence to support widespread implementation of TOR rules in clinical practice. These findings suggest that adoption of TOR rules may lead to missed survivors and increased resource utilization.

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“…First-pass title and abstract screening yielded 131 potentially eligible studies. After the second-pass full-text screening, 43 studies remained (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Termination of Resuscitation Rules and Survival Among Patients With Out-of-Hospital Cardiac Arrest

Smyth,

Gunson,

Coppola

et al. 2024

JAMA Netw Open

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“…ECPR im geschilderten Fall überhaupt gerechtfertigt sind oder ob man nicht die Reanimationsbemühungen bei initialer Asystolie und bisheriger Erfolglosigkeit der CPR zeitnah hätte einstellen sollen? Gemäß der "Advanced Life Support Termination of Resuscitation Rule" (ALS-TOR) sollte die Reanimation unter folgenden modifizierten Bedingungen beendet werden: kein schockbarer Rhythmus, kein beobachteter Kreislaufstillstand, keine Laienreanimation, kein ROSC vor möglichem Transportbeginn [37]. Im beschriebenen Fall sprachen 2 Punkte (beobachteter Kreislaufstillstand, durchgeführte Laienreanimation) gegen die frühzeitige Anwendung der ALS-TOR.…”

Section: Fall -Ohcaunclassified

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) im prähospitalen Einsatz – Präsentation zweier Fälle

Hilbert-Carius,

Siebenborn,

Bielert

et al. 2024

NOTARZT

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ZusammenfassungResuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) ist ein wenig invasives Verfahren, um ein „internes“ Cross-Clamping der Aorta durchzuführen. Hierdurch ist es entweder möglich, den Blutverlust bei nicht komprimierbaren Körperstammblutungen zu reduzieren und den Patienten vor dem Verbluten zu retten oder im Rahmen der Herz-Lungen-Wiederbelebung (CPR) den koronaren und zerebralen Perfusionsdruck zu erhöhen und damit eventuell die ROSC-Rate und das neurologische Outcome zu verbessern. Aktuell findet REBOA in Deutschland nur in einigen Traumazentren im Schockraum Anwendung und der prähospitale Einsatz ist eher eine extrem seltene Ausnahme. Wir berichten über 2 Fälle, in denen das Verfahren im Rahmen des RIBCAP-HEMS-Projektes (REBOA In Bleeding and Cardiac Arrest in the Pre-hospital care by Helicopter Emergency Medical Service) prähospital durch das Team eines Rettungshubschraubers der DRF Luftrettung jeweils bei der CPR sowie beim Trauma angewendet wurde.

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“…The Guidelines for the termination of cardiopulmonary resuscitation (TOR) efforts were published by the American Heart Association (AHA) in 2010 and by the European CPR Guidelines in 2015. The advanced life support TOR rules recommend that when all the following criteria are met, CPR should be discontinued: the cardiac arrest was unwitnessed, no bystander CPR occurred, no shock was delivered, and efforts did not result in return of spontaneous circulation (ROSC) [3,4]. In clinical practice, identification of all these factors is not always easy or possible in such a short time as needed to start and discontinue CPR.…”

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confidence: 99%

The decision-making process in out-of-hospital cardiac arrest: from complexity to opportunities

Lazzeri

Bonizzoli

Peris

2023

European Journal of Emergency Medicine

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Out-of-hspital cardiac arrest (OHCA) is a time-dependent condition associated with high mortality, since, if optimally managed, only 20% of patients survive. Initial management (i.e. witnessed vs. unwitnessed, involvement of non-healthcare subjects, public vs. private place) and the critical baseline condition (cardiac vs. non-cardiac cause) are probably the main factors able to affect subjects in terms of survival and neurological outcome [1].Despite growing research in this field, the decision-making process in OHCA is still quite challenging for emergency physicians [both in pre-hospital care setting and at the emergency department (ED)].

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Termination of resuscitation in out-of-hospital cardiac arrest in women and men: An ESCAPE-NET project

Cited by 5 publications

References 34 publications

Termination of Resuscitation Rules and Survival Among Patients With Out-of-Hospital Cardiac Arrest

Termination of Resuscitation Rules and Survival Among Patients With Out-of-Hospital Cardiac Arrest

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) im prähospitalen Einsatz – Präsentation zweier Fälle

The decision-making process in out-of-hospital cardiac arrest: from complexity to opportunities

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