Out-of-hospital cardiac arrest termination of resuscitation with ongoing CPR: An observational study

E J Yates; S Schmidbauer; A M Smyth; M Ward; S Dorrian; A N Siriwardena; H Friberg; G D Perkins

doi:10.1016/j.resuscitation.2018.06.021

Out-of-hospital cardiac arrest termination of resuscitation with ongoing CPR: An observational study

Resuscitation. 2018 Sep:130:21-27. doi: 10.1016/j.resuscitation.2018.06.021. Epub 2018 Jun 27.

Authors

E J Yates¹, S Schmidbauer², A M Smyth³, M Ward⁴, S Dorrian⁵, A N Siriwardena⁶, H Friberg², G D Perkins⁷

Affiliations

¹ Critical Care Unit, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, West Midlands, UK. Electronic address: elliotyatesj@gmail.com.
² Lund University, Skåne University Hospital, Dept. of Clinical Sciences, Anaesthesiology and Intensive Care, Malmö, Sweden; Center for Cardiac Arrest at Lund University, Lund University, Lund, Sweden.
³ Warwick Clinical Trials Unit, University of Warwick, Coventry, UK; West Midlands Ambulance Service NHS Foundation Trust, West Midlands, UK.
⁴ West Midlands Ambulance Service NHS Foundation Trust, West Midlands, UK.
⁵ Department of Emergency Medicine, University Hospitals Birmingham NHS Foundation Trust, West Midlands, UK.
⁶ Community and Health Research Unit, School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK.
⁷ Critical Care Unit, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, West Midlands, UK.

PMID: 29958956
DOI: 10.1016/j.resuscitation.2018.06.021

Abstract

Introduction: Termination of resuscitation guidelines for out-of-hospital cardiac arrest can identify patients in whom continuing resuscitation has little chance of success. This study examined the outcomes of patients transferred to hospital with ongoing CPR. It assessed outcomes for those who would have met the universal prehospital termination of resuscitation criteria (no shocks administered, unwitnessed by emergency medical services, no return of spontaneous circulation).

Methods: A retrospective cohort study of consecutive adult patients who were transported to hospital with ongoing CPR was conducted at three hospitals in the West Midlands, UK between September 2016 and November 2017. Patient characteristics, interventions and response to treatment (ROSC, survival to discharge) were identified.

Results: 227 (median age 69 years, 67.8% male) patients were identified. 89 (39.2%) met the universal prehospital termination of resuscitation criteria. Seven (3.1%) were identified with a potentially reversible cause of cardiac arrest. After hospital arrival, patients received few specialist interventions that were not available in the prehospital setting. Most (n = 210, 92.5%) died in the emergency department. 17 were admitted (14 to intensive care), of which 3 (1.3%) survived to hospital discharge. There were no survivors (0%) in those who met the criteria for universal prehospital termination of resuscitation.

Conclusion: Overall survival amongst patients transported to hospital with ongoing CPR was very poor. Application of the universal prehospital termination of resuscitation rule, in patients without obvious reversible causes of cardiac arrest, would have allowed resuscitation to have been discontinued at the scene for 39.2% of patients who did not survive.

Keywords: CPR; Cardiac arrest; Cardiopulmonary resuscitation; Decision support techniques; OHCA; Ongoing CPR, observational; Out-of-hospital cardiac arrest; ROSC; Return of spontaneous circulation; Survival to discharge; TOR; Termination of resuscitation; UK; Universal prehospital termination of resuscitation rule; West Midlands.

Publication types

Observational Study

MeSH terms

Aged
Cardiopulmonary Resuscitation* / adverse effects
Cardiopulmonary Resuscitation* / methods
Cardiopulmonary Resuscitation* / statistics & numerical data
Decision Support Techniques
Emergency Medical Services* / methods
Emergency Medical Services* / statistics & numerical data
Female
Humans
Male
Out-of-Hospital Cardiac Arrest* / mortality
Out-of-Hospital Cardiac Arrest* / therapy
Outcome and Process Assessment, Health Care
Resuscitation Orders*
Survival Analysis
United Kingdom / epidemiology