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Survival rates in out-of-hospital cardiac arrest patients transported without prehospital return of spontaneous circulation: an observational cohort study.
Resuscitation. 2014 Nov; 85(11):1488-93.R

Abstract

BACKGROUND

Some Emergency Medical Services currently use just one component of the Universal Termination of Resuscitation (TOR) Guideline, the absence of prehospital return of spontaneous circulation (ROSC), as the single criteria to terminate resuscitation, which may deny transport to potential survivors.

OBJECTIVE

This study aimed to report the survival to hospital discharge rate in non-traumatic, adult out-of-hospital cardiac arrest (OHCA) patients transported to hospital without a prehospital ROSC.

METHODS

An observational study of OHCA patients without a prehospital ROSC who met the Universal TOR Guideline for transport to hospital with ongoing resuscitation. Multivariable logistic regression was used to determine the association of each variable with survival to hospital discharge.

RESULTS

Of 20,207 OHCA treated by EMS, 3374 (16.4%) did not have a prehospital ROSC but met the Universal TOR guideline for transport to hospital with ongoing resuscitation. Of these patients, 122 (3.6%) survived to hospital discharge. Survival to discharge was associated with initial shockable VF/VT rhythms (OR 5.07; 95% CI 2.77-9.30), EMS-witnessed arrests (OR 3.51; 95% CI 1.73-7.15), bystander-witnessed arrests (OR 2.11; 95% CI 1.18-3.77), and public locations (OR 1.57; 95% CI 1.02-2.40).

CONCLUSION

In OHCA patients without a prehospital ROSC who met the Universal TOR Guideline for transport with ongoing resuscitation survival rates were above the 1% futility rate. Employing only the lack of ROSC as criteria for termination of resuscitation may miss survivors after OHCA.

Authors+Show Affiliations

Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, Department of Medicine, University of Toronto, Toronto, Canada; York Region Emergency Medical Services, Ontario, Canada. Electronic address: DrennanI@smh.ca.Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: LinS@smh.ca.Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Electronic address: Daniel.Sidalak@gmail.com.Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, Department of Medicine, University of Toronto, Toronto, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: MorrisonL@smh.ca.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

25128746

Citation

Drennan, Ian R., et al. "Survival Rates in Out-of-hospital Cardiac Arrest Patients Transported Without Prehospital Return of Spontaneous Circulation: an Observational Cohort Study." Resuscitation, vol. 85, no. 11, 2014, pp. 1488-93.
Drennan IR, Lin S, Sidalak DE, et al. Survival rates in out-of-hospital cardiac arrest patients transported without prehospital return of spontaneous circulation: an observational cohort study. Resuscitation. 2014;85(11):1488-93.
Drennan, I. R., Lin, S., Sidalak, D. E., & Morrison, L. J. (2014). Survival rates in out-of-hospital cardiac arrest patients transported without prehospital return of spontaneous circulation: an observational cohort study. Resuscitation, 85(11), 1488-93. https://doi.org/10.1016/j.resuscitation.2014.07.011
Drennan IR, et al. Survival Rates in Out-of-hospital Cardiac Arrest Patients Transported Without Prehospital Return of Spontaneous Circulation: an Observational Cohort Study. Resuscitation. 2014;85(11):1488-93. PubMed PMID: 25128746.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Survival rates in out-of-hospital cardiac arrest patients transported without prehospital return of spontaneous circulation: an observational cohort study. AU - Drennan,Ian R, AU - Lin,Steve, AU - Sidalak,Daniel E, AU - Morrison,Laurie J, Y1 - 2014/08/13/ PY - 2014/02/27/received PY - 2014/05/21/revised PY - 2014/07/15/accepted PY - 2014/8/17/entrez PY - 2014/8/17/pubmed PY - 2015/8/13/medline KW - Cardiac arrest KW - Emergency medical services KW - Out-of-hospital cardiac arrest KW - Termination of resuscitation SP - 1488 EP - 93 JF - Resuscitation JO - Resuscitation VL - 85 IS - 11 N2 - BACKGROUND: Some Emergency Medical Services currently use just one component of the Universal Termination of Resuscitation (TOR) Guideline, the absence of prehospital return of spontaneous circulation (ROSC), as the single criteria to terminate resuscitation, which may deny transport to potential survivors. OBJECTIVE: This study aimed to report the survival to hospital discharge rate in non-traumatic, adult out-of-hospital cardiac arrest (OHCA) patients transported to hospital without a prehospital ROSC. METHODS: An observational study of OHCA patients without a prehospital ROSC who met the Universal TOR Guideline for transport to hospital with ongoing resuscitation. Multivariable logistic regression was used to determine the association of each variable with survival to hospital discharge. RESULTS: Of 20,207 OHCA treated by EMS, 3374 (16.4%) did not have a prehospital ROSC but met the Universal TOR guideline for transport to hospital with ongoing resuscitation. Of these patients, 122 (3.6%) survived to hospital discharge. Survival to discharge was associated with initial shockable VF/VT rhythms (OR 5.07; 95% CI 2.77-9.30), EMS-witnessed arrests (OR 3.51; 95% CI 1.73-7.15), bystander-witnessed arrests (OR 2.11; 95% CI 1.18-3.77), and public locations (OR 1.57; 95% CI 1.02-2.40). CONCLUSION: In OHCA patients without a prehospital ROSC who met the Universal TOR Guideline for transport with ongoing resuscitation survival rates were above the 1% futility rate. Employing only the lack of ROSC as criteria for termination of resuscitation may miss survivors after OHCA. SN - 1873-1570 UR - https://www.unboundmedicine.com/medline/citation/25128746/Survival_rates_in_out_of_hospital_cardiac_arrest_patients_transported_without_prehospital_return_of_spontaneous_circulation:_an_observational_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(14)00654-6 DB - PRIME DP - Unbound Medicine ER -