title: Prehospital termination of resuscitation in cases of refractory out-of-hospital cardiac arrest.
abstract: BACKGROUND
  Identifying patients in the out-of-hospital setting who have no realistic hope of surviving an out-of-hospital cardiac arrest could enhance utilization of scarce health care resources.
  
  
  OBJECTIVE
  To validate 2 out-of-hospital termination-of-resuscitation rules developed by the Ontario Prehospital Life Support (OPALS) study group, one for use by responders providing basic life support (BLS) and the other for those providing advanced life support (ALS).
  
  
  METHODS
  Retrospective cohort study using surveillance data prospectively submitted by emergency medical systems and hospitals in 8 US cities to the Cardiac Arrest Registry to Enhance Survival (CARES) between October 1, 2005, and April 30, 2008. Case patients were 7235 adults with out-of-hospital cardiac arrest; of these, 5505 met inclusion criteria.
  
  
  METHODS
  Specificity and positive predictive value of each termination-of-resuscitation rule for identifying patients who likely will not survive to hospital discharge.
  
  
  RESULTS
  The overall rate of survival to hospital discharge was 7.1% (n = 392). Of 2592 patients (47.1%) who met BLS criteria for termination of resuscitation efforts, only 5 (0.2%) patients survived to hospital discharge. Of 1192 patients (21.7%) who met ALS criteria, none survived to hospital discharge. The BLS rule had a specificity of 0.987 (95% confidence interval [CI], 0.970-0.996) and a positive predictive value of 0.998 (95% CI, 0.996-0.999) for predicting lack of survival. The ALS rule had a specificity of 1.000 (95% CI, 0.991-1.000) and positive predictive value of 1.000 (95% CI, 0.997-1.000) for predicting lack of survival.
  
  
  CONCLUSIONS
  In this validation study, the BLS and ALS termination-of-resuscitation rules performed well in identifying patients with out-of-hospital cardiac arrest who have little or no chance of survival.
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, USA. comilla@umich.edu
authors.forename: Comilla
authors.initials: C
authors.lastname: Sasson
authors.forename: A J
authors.initials: AJ
authors.lastname: Hegg
authors.forename: Michelle
authors.initials: M
authors.lastname: Macy
authors.forename: Allison
authors.initials: A
authors.lastname: Park
authors.forename: Arthur
authors.initials: A
authors.lastname: Kellermann
authors.forename: Bryan
authors.initials: B
authors.lastname: McNally
mesh_terms: D000328:Adult; D022561:Advanced Cardiac Life Support / Q000592:standards; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000592:standards; D002985:Clinical Protocols; D004632:Emergency Medical Services / Q000592:standards; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D018447:Medical Futility; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States; D028761:Withholding Treatment / Q000592:standards