Criteria Identified to Predict Nonsurvival of Extrahospital Cardiac Arrest

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Title: Criteria Identified to Predict Nonsurvival of Extrahospital Cardiac Arrest
URL: http://www.pslgroup.com/dg/22D716.htm
Doctor's Guide
September 24, 2008

CHICAGO -- September 24, 2008 -- Researchers have validated criteria used to identify patients with out-of-hospital cardiac arrest who have little or no chance of survival after resuscitation, according to a study in the September 24 issue of the Journal of the American Medical Association.

"During the past 30 years, several research teams have sought to define objective clinical criteria to identify patients who likely will not benefit from rapid transport to the hospital for further resuscitative efforts," the authors wrote.

"Despite this research, many emergency medical services (EMS) systems still urgently transport patients with refractory cardiac arrest to the hospital for continued resuscitative efforts. Rapid transport with lights and siren may pose hazards for EMS personnel and the public and should occur only when the risks of high-speed transport are justified by the potential benefits to the patient."

Comilla Sasson, MD, University of Michigan, Ann Arbor, Michigan, and colleagues conducted a study to validate 2 out-of-hospital termination-of-resuscitation rules developed by the Ontario Prehospital Life Support (OPALS) study group. One rule is used by responders providing basic life support (BLS), and the other rule is for those providing advanced life support (ALS).

The researchers analysed surveillance data submitted by EMS systems and hospitals in 8 US cities that were part of the Cardiac Arrest Registry to Enhance Survival (CARES). The study included 5,505 adults with out-of-hospital cardiac arrest.

The BLS rules include (1) event not witnessed by EMS personnel, (2) no automated external defibrillator used or manual shock applied in the out-of-hospital setting, and (3) no return of spontaneous circulation in the out-of-hospital setting. The ALS rules include the 3 BLS rules plus an additional 2 rules: (4) arrest not witnessed by bystander and (5) no bystander-administered cardiopulmonary resuscitation.

The researchers found that the overall rate of survival to hospital discharge was 7.1% (n = 392). Of 2,592 patients (47.1%) who met BLS criteria for termination of resuscitation efforts, only 5 (0.2%) survived to hospital discharge. Of 1,192 patients (21.7%) who met ALS criteria, none survived to hospital discharge.

The BLS rule had a positive predictive value of 0.998 for predicting lack of survival; the ALS rule had a positive predictive value of 1.000 for predicting lack of survival.

"Widespread implementation of either rule could materially reduce the risk posed to EMS personnel during high-speed transports, decrease pressure on overburdened EMS systems, allow emergency department staff to focus on patients who have greater odds of survival, and decrease admissions to the intensive care unit of patients with out-of-hospital cardiac arrest who have little or no chance of surviving to discharge," the authors wrote.

SOURCE: Journal of the American Medical Association

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