Validation of a Rule for Termination of Resuscitation in Out-of-Hospital Cardiac Arrest

Morrison, Laurie J.; Visentin, Laura; Kiss, Alex; Theriault, Rob; Eby, Don; Vermeulen, Marian J.; Sherbino, Jonathan; Verbeek, P. Richard

doi:10.1056/nejmoa052620

Cited by 277 publications

(185 citation statements)

References 34 publications

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“…Key factors include arrest witnessed by a bystander, arrest witnessed by EMS, provision of bystander cardiopulmonary resuscitation (CPR), shockable rhythm at EMS arrival, and return of spontaneous circulation (ROSC) in the field. 5 The last two measures have the biggest effect on survival, suggesting a need for timely EMS interventions and community preparedness to provide out-ofhospital life support measures. Even in EMS systems with short transport times and consistent implementation of evidence-based prehospital care, the survival rates for OHCA come up to only about 20%.…”

mentioning

confidence: 99%

Differential Survival for Men and Women from Out-of-hospital Cardiac Arrest Varies by Age: Results from the OPALS Study

et al. 2014

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mentioning

confidence: 99%

Differential Survival for Men and Women from Out-of-hospital Cardiac Arrest Varies by Age: Results from the OPALS Study

et al. 2014

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“…7 Compared to cardiac etiology OHCA patients, drowning patients in Ontario were more often transported to hospital, which is most likely attributable to the fact that drownings are excluded from the application of termination of resuscitation guidelines. 20,21 Drowning patients were more often admitted to hospital alive compared to cardiac OHCA patients, although there was no difference in survival to hospital discharge. This increase in short-term survival could be explained by the relatively public nature of drownings, which predominantly occur outside or in a shared space and are thus more likely to attract a crowd response.…”

Section: Discussionmentioning

confidence: 93%

“…Treated cardiac arrests of presumed cardiac etiology were eligible for prehospital termination of resuscitation after paramedics consulted with an online medical director or base hospital physician based on a previously validated tool for any unwitnessed arrest, with no defibrillator shocks delivered and no return of spontaneous circulation. 20,21 The resuscitation of drowning OHCA patients was terminated only after direction from the online medical director or base hospital physician as OHCA attributed to drowning falls outside the termination of resuscitation protocol.…”

Section: Setting and Patient Selectionmentioning

confidence: 99%

Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada

Buick

Lin

Rac

et al. 2014

CJEM

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Introduction: Drowning is a major public health concern, yet little is known about the characteristics of drowning patients. The objectives of this study were to describe the demographic and clinical characteristics of out-of-hospital cardiac arrest (OHCA) attributed to drowning in Ontario and to compare the characteristics of OHCA attributed to drowning to those of presumed cardiac etiology. Methods: A retrospective, observational study was carried out of consecutive OHCA patients of drowning etiology in Ontario between August 2006 and July 2011. Bivariate analysis was used to evaluate differences between drowning and presumed cardiac etiologies. Results: A total of 31,763 OHCA patients were identified, and 132 (0.42%) were attributed to drowning. Emergency medical services treated 98 patients, whereas the remaining 34 met the criteria for legislative death. Overall, 5.1% of drowning patients survived to hospital discharge. When compared to patients of presumed cardiac etiology, drowning patients were younger and their arrest was more likely to be unwitnessed, present with a nonshockable initial rhythm, occur in a public location, and receive bystander cardiopulmonary resuscitation (CPR). A nonsignificant trend was noted for drowning cases to more frequently have a public access AED applied. There were no significant differences in the gender ratio or paramedic response times. Drowning patients were more likely to be transported to hospital but had a trend to be less likely to arrive with a return of spontaneous circulation. They were also more likely to be admitted to hospital but had no difference in survival to hospital discharge. Conclusions: Significant differences exist between OHCA of drowning and presumed cardiac etiologies. Most drownings are unwitnessed, occur in public locations, and present with nonshockable initial rhythms, suggesting that treatment should focus on bystander CPR. Future initiatives should focus on strategies to improve supervision in targeted locations and greater emphasis on bystander-initiated CPR, both of which may reduce drowning mortality.

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“…2,8,9,11,[17][18][19][20][21][22] Similarly, EMS researchers have addressed policy matters, such as termination of resuscitation, hospital bypass, and ED offload delay. 23,24 Workforce issues, such as clinical judgment, workplace violence, and occupational hazards, have also been scientifically investigated. 25,26,27 "Reverse translation"…”

Section: Ems-centred Researchmentioning

confidence: 99%

Applying Hospital Evidence to Paramedicine: Issues of Indirectness, Validity and Knowledge Translation

Bigham

Welsford

2015

CJEM

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The practice of emergency medicine (EM) has been intertwined with emergency medical services (EMS) for more than 40 years. In this commentary, we explore the practice of translating hospital based evidence into the prehospital setting. We will challenge both EMS and EM dogmabringing hospital care to patients in the field is not always better. In providing examples of therapies championed in hospitals that have failed to translate into the field, we will discuss the unique prehospital environment, and why evidence from the hospital setting cannot necessarily be translated to the prehospital field. Paramedicine is maturing so that the capability now exists to conduct practice-specific research that can inform best practices. Before translation from the hospital environment is implemented, evidence must be evaluated by people with expertise in three domains: critical appraisal, EM, and EMS. Scientific evidence should be assessed for: quality and bias; directness, generalizability, and validity to the EMS population; effect size and anticipated benefit from prehospital application; feasibility (including economic evaluation, human resource availability in the mobile environment); and patient and provider safety. RÉSUMÉLa pratique de la médecine d'urgence (MU) est étroitement liée aux services médicaux d'urgence (SMU) depuis plus d'une quarantaine d'années. Aussi les auteurs traitent-ils, dans le présent article, du transfert des données probantes, du milieu hospitalier au milieu préhospitalier. Sera remis en question un dogme admis tant par la MU que par les SMU; en effet, le transfert, sur le terrain, des pratiques en milieu hospitalier n'est pas toujours la meilleure solution. Il sera question, à l'aide d'exemples de traitements préconisés dans les hôpitaux qui se sont soldés par des échecs sur le terrain, du caractère propre du milieu préhospitalier et des raisons pour lesquelles l'application directe des données probantes, recueillies en milieu hospitalier ne convient pas nécessairement au milieu préhospitalier. Les secours paramédicaux sont une discipline en évolution, si bien que la capacité de recherche sur la pratique est suffisamment importante pour jeter une lumière nouvelle sur les pratiques exemplaires. Avant d'envisager l'application des connaissances recueillies en milieu hospitalier, il faut que les données probantes à l'appui soient évaluées par des experts dans trois domaines: l'évaluation critique, la MU et les SMU. Les données probantes de scientifiques devrait faire l'objet d'examen à l'égard: de la qualité et des biais; de l'application directe des données dans la population visée par les SMU ainsi que de leur généralisabilité et de leur validité; de l'ampleur de l'effet et des avantages prévisibles de l'application préhospitalière de ces pratiques; de la faisabilité (y compris l'évaluation économique et la suffisance des ressources humaines dans un environnement mobile); et finalement de la sécurité tant des patients que des fournisseurs de soins.

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Validation of a Rule for Termination of Resuscitation in Out-of-Hospital Cardiac Arrest

Abstract: The use of a clinical prediction rule for the termination of resuscitation may help clinicians decide whether to terminate basic life support resuscitative efforts in patients having an out-of-hospital cardiac arrest.

Cited by 277 publications

References 34 publications

Differential Survival for Men and Women from Out-of-hospital Cardiac Arrest Varies by Age: Results from the OPALS Study

Differential Survival for Men and Women from Out-of-hospital Cardiac Arrest Varies by Age: Results from the OPALS Study

Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada

Applying Hospital Evidence to Paramedicine: Issues of Indirectness, Validity and Knowledge Translation

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