Clinical decision rules for termination of resuscitation in out-of-hospital cardiac arrest.
BACKGROUND
Out-of-hospital cardiac arrest (OHCA) has a low probability of survival to hospital discharge. Four clinical decision rules (CDRs) have been validated to identify patients with no probability of survival. Three of these rules focus on exclusive prehospital basic life support care for OHCA, and two of these rules focus on prehospital advanced life support care for OHCA.


OBJECTIVE
Can a CDR for the termination of resuscitation identify a patient with no probability of survival in the setting of OHCA?


METHODS
Six validation studies were selected from a PubMed search. A structured review of each of the studies is presented.


RESULTS
In OHCA receiving basic life support care, the BLS-TOR (basic life support termination of resuscitation) rule has a positive predictive value for death of 99.5% (95% confidence interval 98.9-99.8%), and decreases the transportation of all patients by 62.6%. This rule has been appropriately validated for widespread use. In OHCA receiving advanced life support care, no current rule has been appropriately validated for widespread use.


CONCLUSIONS
The BLS-TOR rule is a simple rule that identifies patients who will not survive OHCA. Further research is required to identify similarly robust CDRs for patients receiving advanced life support care in the setting of OHCA.
Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada.
Jonathan
J
Sherbino
Samuel M
SM
Keim
Daniel P
DP
Davis
D000368:Aged; D016887:Cardiopulmonary Resuscitation; D003661:Decision Support Techniques; D004632:Emergency Medical Services; D019317:Evidence-Based Medicine; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D018447:Medical Futility