Predicting the outcome of unsuccessful prehospital advanced cardiac life support.
OBJECTIVE
To determine if failure to achieve return of spontaneous circulation following prehospital advanced cardiac life support (ACLS) warrants termination of efforts at the scene.


METHODS
Retrospective case series.


METHODS
Memphis, Tenn, a city of 610337 people that is served by a fire department-based emergency medical service system. All city ambulances provide ACLS.


METHODS
Adult victims of out-of-hospital cardiac arrest due to heart disease.


METHODS
All patients received prehospital ACLS according to the 1986 American Heart Association guidelines. Following prehospital ACLS, all patients were transported to the nearest hospital emergency department whether or not a pulse was restored in the field.


METHODS
Survival to hospital admission, survival to hospital discharge, and neurological status at discharge.


RESULTS
Over the 39-month study interval, the Memphis Fire Department treated 1068 victims of out-of-hospital cardiac arrest. Three hundred ten of these (29%) had return of spontaneous circulation prior to transport for some period. The remaining 758 patients (71%) never regained a pulse and were transported with ongoing cardiopulmonary resuscitation. Patients who had return of spontaneous circulation prior to transport were more likely to be admitted (69% vs 7.0%) and far more likely to be discharged alive (26.5% vs 0.4%) than patients who failed to respond to prehospital ACLS. Three patients who survived to hospital discharge despite failure to achieve return of spontaneous circulation prior to emergency medical service transport sustained their cardiac arrest after paramedic arrival. All three were discharged with moderate to severe cerebral disability.


CONCLUSIONS
Rapid transport of adults who fail to respond to an adequate trial of prehospital ACLS does not result in meaningful rates of survival. In such cases, on-line emergency medical service physicians should authorize paramedics to cease efforts in the field.
Division of Emergency Medicine, University of Tennessee, Memphis.
A L
AL
Kellermann
B B
BB
Hackman
G
G
Somes
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000592:standards* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D016414:Resuscitation Orders; D012189:Retrospective Studies; D016019:Survival Analysis; D013714:Tennessee; D017211:Treatment Failure