Termination of resuscitation: a guide to interpreting the literature.
BACKGROUND
Prehospital termination of resuscitation rules are used to decide on one of two actions: to continue resuscitation and transport to hospital or to terminate resuscitation. The literature is confusing as some rules are derived with survival as the outcome of interest (predicting when to transport and reporting sensitivity and negative predictive value) and other rules use death (predicting when to terminate resuscitation and reporting specificity and positive predictive value). Very few publish the EMS transport rate when the rule is applied; the outcome of interest to EMS services.


METHODS
We propose to review the test characteristics and transport rates of the decision rules published between 1966 and 2007.


RESULTS
We identified 9 analyses of 6 termination of resuscitation rules; 1 inhospital, and 5 prehospital (2 advance and 3 basic life support providers). The inhospital and the basic life support rules were derived using survival whereas the advance life support rules were derived using death. The transport rate was published in two studies. When all the rules were reanalysed for death the specificity varied from 90.2% to 100%, the positive predictive value from 99.5% to 100% and the transport rate varied from 37% to 91%.


CONCLUSIONS
We suggest that the diagnostic test characteristics of termination of resuscitation rules should be reported with death as the primary outcome which identifies for the paramedics futile resuscitations that should be terminated in the field. We also emphasize the need to report transport rates to provide the EMS services with an implementation benchmark.
Morrison
Laurie J
LJ
Prehospital and Transport Medicine Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. laurie.morrison@sunnybrook.ca
Bigham
Blair L
BL
Kiss
Alex
A
Verbeek
P Richard
PR
D006801:Humans; D016414:Resuscitation Orders