Implementation trial of the basic life support termination of resuscitation rule: Reducing the transport of futile out-of-hospital cardiac arrests Academic Article uri icon

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abstract

  • BACKGROUND: The basic life support (BLS) termination of resuscitation (TOR) rule recommends transport and continued resuscitation when cardiac arrest is witnessed by EMT-Ds, or there is a return of spontaneous circulation, or a shock is given, and prior studies have suggested the transport rate should fall to 37%. METHODS AND RESULTS: This real-time prospective multi-center implementation trial evaluated the BLS TOR rule for compliance, transport rate and provider and physician comfort. Both provider and physician noted their decision-making rationale and ranked their comfort on a 5-point Likert scale. Functional survival was measured at discharge. Of 2421 cardiac arrests, 953 patients were eligible for the rule, which was applied correctly for 755 patients (79%) of which 388 were terminated. 565 patients were transported resulting in a reduction of the transport rate from 100% (historical control) to 59% (p<0.001). The BLS TOR rule was not followed in 198 eligible patients (21%) and they were all transported despite meeting the criteria to terminate. Providers cited 241 reasons for non-compliance: family distress, short transport time interval, younger age and public venue. All 198 transported patients, non-compliant with the rule, died. Both providers and physicians were comfortable with using the rule to guide TOR (median [IQR] of 5 [4,5]; p<0.001). CONCLUSIONS: This implementation trial confirmed the accuracy of the BLS TOR rule in identifying futile out-of-hospital cardiac arrest (OHCA) resuscitations, significantly reduced the transport rate of futile OHCA and most providers and physicians were comfortable following the rule's recommendations.

authors

  • Morrison, Laurie J
  • Eby, Don
  • Veigas, Precilla V
  • Zhan, Cathy
  • Kiss, Alex
  • Arcieri, Vince
  • Hoogeveen, Paul
  • Loreto, Chris
  • Welsford, Michelle
  • Dodd, Tim
  • Mooney, Elma
  • Pilkington, Marty
  • Prowd, Cathy
  • Reichl, Erica
  • Scott, Jim
  • Verdon, Jeanette M
  • Waite, Tim
  • Buick, Jason E
  • Verbeek, P Richard

publication date

  • April 2014

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