title: Out-of-hospital unwitnessed cardiopulmonary collapse and no-bystander CPR: a practical addition to resuscitation termination guidelines.
abstract: Cardiopulmonary resuscitation (CPR) provides possible survival from otherwise fatal cardiopulmonary collapse. Termination guidelines have been developed for use when resuscitation has no potential benefit for a victim. The purpose of this prospective cohort study was to determine if unwitnessed collapse combined with no-bystander cardiopulmonary resuscitation would support a decision to terminate attempted resuscitation. There were 541 patients analyzed during 6 months, with functional neurological survival the outcome of interest. There were no functional neurological survivors at hospital discharge among the 180 victims in the unwitnessed, no-bystander CPR subgroup (95% confidence interval [CI] 0.0%-2.1%). Functional neurological survival for witnessed collapse, bystander CPR was 6.0% (95% CI 2.8%-12.5%), for witnessed collapse, no-bystander CPR was 3.8% (95% CI 1.9%-7.7%), and for unwitnessed collapse, bystander CPR 1.3% (95% CI 0.2%-6.9%). With confirmation by further studies, unwitnessed collapse and lack of bystander CPR may be a practical addition to resuscitation termination guidelines.
authors.affiliation: Department of Emergency Medicine, University of California, Irvine School of Medicine, Irvine, California, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Stratton
authors.forename: Paula
authors.initials: P
authors.lastname: Rashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016414:Resuscitation Orders; D016019:Survival Analysis; D016896:Treatment Outcome; D014505:Urban Population