title: Survival rates in out-of-hospital cardiac arrest patients transported without prehospital return of spontaneous circulation: an observational cohort study.
abstract: BACKGROUND
  Some Emergency Medical Services currently use just one component of the Universal Termination of Resuscitation (TOR) Guideline, the absence of prehospital return of spontaneous circulation (ROSC), as the single criteria to terminate resuscitation, which may deny transport to potential survivors.
  
  
  OBJECTIVE
  This study aimed to report the survival to hospital discharge rate in non-traumatic, adult out-of-hospital cardiac arrest (OHCA) patients transported to hospital without a prehospital ROSC.
  
  
  METHODS
  An observational study of OHCA patients without a prehospital ROSC who met the Universal TOR Guideline for transport to hospital with ongoing resuscitation. Multivariable logistic regression was used to determine the association of each variable with survival to hospital discharge.
  
  
  RESULTS
  Of 20,207 OHCA treated by EMS, 3374 (16.4%) did not have a prehospital ROSC but met the Universal TOR guideline for transport to hospital with ongoing resuscitation. Of these patients, 122 (3.6%) survived to hospital discharge. Survival to discharge was associated with initial shockable VF/VT rhythms (OR 5.07; 95% CI 2.77-9.30), EMS-witnessed arrests (OR 3.51; 95% CI 1.73-7.15), bystander-witnessed arrests (OR 2.11; 95% CI 1.18-3.77), and public locations (OR 1.57; 95% CI 1.02-2.40).
  
  
  CONCLUSIONS
  In OHCA patients without a prehospital ROSC who met the Universal TOR Guideline for transport with ongoing resuscitation survival rates were above the 1% futility rate. Employing only the lack of ROSC as criteria for termination of resuscitation may miss survivors after OHCA.
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, Department of Medicine, University of Toronto, Toronto, Canada; York Region Emergency Medical Services, Ontario, Canada. Electronic address: DrennanI@smh.ca.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Drennan
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: LinS@smh.ca.
authors.forename: Steve
authors.initials: S
authors.lastname: Lin
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Electronic address: Daniel.Sidalak@gmail.com.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Sidalak
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, Department of Medicine, University of Toronto, Toronto, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: MorrisonL@smh.ca.
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality*; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D010343:Patient Admission / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis
keywords: Cardiac arrest; Emergency medical services; Out-of-hospital cardiac arrest; Termination of resuscitation