Termination of resuscitation: Recognising futility

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Abstract

Purpose: To identify futile resuscitation attempts for adult out of hospital cardiac arrests (OHCA) of presumed cardiac origin, which are currently transported to hospital in the UK. Then to create a decision rule to allow for termination on scene. The results of applying the rule were compared with existing termination decision rules.

Methods: A retrospective cohort study of OHCA data collected by a UK ambulance trust between 1 April 2011 and 29 June 2013 (n = 4870). Logistic regression was performed, which identified that return of spontaneous circulation (ROSC) (OR = 40.1; 95% CI: 25.7% to 62.5%) and initial shockable rhythm (OR = 10.7; 95% CI: 6.6% to 17.2%) had the strongest association with outcome. A decision rule derived from these required where a patient did not present with an initial shockable rhythm, and there was no ROSC on scene; resuscitation could be terminated, without the need for transport. The rule was applied to the dataset and compared against existing Basic Life Support (BLS) [1] and Advanced Life Support (ALS) [2] decision rules.

Results: The rule identified all but five of the 514 survivors (0.2% of terminations) (Specificity 99.0%, 95%CI: 97.7% to 99.7%, sensitivity 53.1%, 95% CI: 51.6% to 54.6%, transport rate = 52.4%). The rule compared favourably with existing BLS and ALS rules which both identified more survivors (Specificity 99.4%, 95% CI: 98.1% to 99.8% and 99.6%, 95% CI: 98.4% to 99.9% respectively), but at the cost of higher transport rates (63.1% and 90.2% respectively).

Conclusions: The NHS is under pressure to reduce spending, whilst improving standards and efficiency. Early decisions, which reduce the need for unnecessary, futile care, are in great demand. The decision rule derived here was able to identify survivors within previously determined thresholds [3]. Furthermore, it identified more futile transportations than existing decision rules.
Original languageEnglish
Article numbere35
JournalResuscitation
Volume118
Issue numberS1
DOIs
Publication statusPublished - 21 Sep 2017

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