title: Re-examining outcomes after unsuccessful out-of-hospital resuscitation in the era of field termination of resuscitation guidelines and regionalized post-resuscitation care.
abstract: BACKGROUND
  Dismal prognosis after failed out-of-hospital resuscitation has previously been demonstrated. Changes in resuscitation and post-resuscitation care may affect patient outcomes. We describe characteristics and outcomes of patients with out-of-hospital cardiac arrest (OOHCA) transported to specialty cardiac centers after failure of out-of-hospital interventions.
  
  
  METHODS
  In Los Angeles (LA) County, patients with non-traumatic OOHCA with return of spontaneous circulation (ROSC) are transported to specialized cardiac care centers. Outcomes are reported to a registry maintained by the LA County Emergency Medical Services (EMS) Agency. We report patient characteristics and outcomes for the subset of patients treated at these specialty centers in whom initial ROSC was achieved in the ED. The primary outcome was neurologically intact survival, defined by a cerebral performance category (CPC) score of 1 or 2.
  
  
  RESULTS
  105 patients transported to the SRC after failure to achieve ROSC with out-of-hospital resuscitation were successfully resuscitated in the ED. The median age was 68 years (IQR 57-78); 74 (70%) were male. The presenting rhythm was ventricular fibrillation or ventricular tachycardia in 40 patients (38%) and 86 (82%) were witnessed. Twenty-two patients (21%) survived to hospital discharge. Of the 103 patients with known CPC scores, 13 (13% [95% CI 7-21%]) survived to hospital discharge with a CPC score of 1 or 2. No patient who survived with good neurologic outcome met criteria for termination of resuscitation in the field.
  
  
  CONCLUSIONS
  Failure of out-of-hospital resuscitation is not universally predictive of poor neurologic outcome.
authors.affiliation: Los Angeles County Emergency Medical Services Agency, 10100 Pioneer Boulevard, Santa Fe Springs, CA, United States; Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, 1000 West Carson Street, Torrance, CA, United States; David Geffen School of Medicine at UCLA, 405 Hilgard Avenue, Los Angeles, CA, United States. Electronic address: nichole.bosson@gmail.com.
authors.forename: Nichole
authors.initials: N
authors.lastname: Bosson
authors.affiliation: Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, 1000 West Carson Street, Torrance, CA, United States; David Geffen School of Medicine at UCLA, 405 Hilgard Avenue, Los Angeles, CA, United States.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
authors.affiliation: Los Angeles County Emergency Medical Services Agency, 10100 Pioneer Boulevard, Santa Fe Springs, CA, United States.
authors.forename: William
authors.initials: W
authors.lastname: Koenig
authors.affiliation: Los Angeles County Emergency Medical Services Agency, 10100 Pioneer Boulevard, Santa Fe Springs, CA, United States.
authors.forename: Paula
authors.initials: P
authors.lastname: Rashi
authors.affiliation: Los Angeles County Emergency Medical Services Agency, 10100 Pioneer Boulevard, Santa Fe Springs, CA, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Tadeo
authors.affiliation: Los Angeles County Emergency Medical Services Agency, 10100 Pioneer Boulevard, Santa Fe Springs, CA, United States.
authors.forename: Deidre
authors.initials: D
authors.lastname: Gorospe
authors.affiliation: Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, 1000 West Carson Street, Torrance, CA, United States; David Geffen School of Medicine at UCLA, 405 Hilgard Avenue, Los Angeles, CA, United States.
authors.forename: James T
authors.initials: JT
authors.lastname: Niemann
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015331:Cohort Studies; D004632:Emergency Medical Services; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Cardiopulmonary resuscitation; Heart arrest; Mortality; Survival