title: Factors associated with initiation of medical advanced cardiac life support after out-of-hospital cardiac arrest.
abstract: BACKGROUND
  Termination of resuscitation rule permits to stop futile resuscitative efforts by paramedics. In a different setting, the decision to withhold resuscitation by emergency physician could be based on different factors. We aimed to identify the factors associated with the initiation of a medical ACLS in out-of-hospital cardiac arrest patients.
  
  
  METHODS
  We prospectively collected the characteristics of all out-of hospital cardiac arrest patients occurring in a French district between March 2010 and December 2013 and managed by the emergency medical system. We analyzed the factors associated with the initiation of medical ACLS.
  
  
  RESULTS
  Medical ACLS was initiated in 69 % of the 2690 patients included in the register. ACLS patients were younger (69 years [55-80] vs. 84 years [77-90]) and more frequently men. A higher percentage of witnessed cardiac arrest and BLS were observed. Duration of no-flow was shorter in the ACLS patients, whereas BLS duration was longer. A higher proportion of shockable rhythm and application of AED were found in this group. Mains factors associated with the initiation of medical ACLS were a suspected cardiac cause (1.73 [1.30-2.30]) and use of an automated external defibrillator (1.59 [1.18-2.16]), whereas factors associated with no medical ACLS were higher age (0.93 [0.92-0.94]), absence of BLS (0.62 [0.52-0.73]), asystole (0.31 [0.18-0.51]) and location in nursing home (0.23 [0.11-0.51]).
  
  
  CONCLUSIONS
  The medical decision to not initiate ACLS in out-of-hospital cardiac arrest patients seems to rely on a complex combination of validated criteria used for termination of resuscitation and factors resulting from an intuitive perception of the outcome.
authors: Medical Surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, 06001, Nice, France.
authors: Jean-Christophe
authors: JC
authors: Orban
authors: Department of Emergency Medicine and SAMU-SMUR, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, 06001, Nice, France.
authors: Didier
authors: D
authors: Giolito
authors: Medical Surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, 06001, Nice, France.
authors: Jordan
authors: J
authors: Tosi
authors: Department of Emergency Medicine, Bastia General Hospital, 20604, Bastia, France.
authors: Franck
authors: F
authors: Le Duff
authors: Department of Emergency Medicine, Antibes General Hospital, 107 avenue de Nice, 06600, Antibes, France.
authors: Nicolas
authors: N
authors: Boissier
authors: Department of Emergency Medicine, Cannes General Hospital, 15 avenue des Broussailles, 06414, Cannes, France.
authors: Christophe
authors: C
authors: Mamino
authors: Department of Emergency Medicine, Princess Grace General Hospital, 1 avenue Pasteur, 98012, Monaco, Monaco.
authors: Emmanuelle
authors: E
authors: Molinatti
authors: Department of Emergency Medicine, Grasse General Hospital, 28 chemin de Clavary, 06130, Grasse, France.
authors: Thai Se
authors: TS
authors: Ung
authors: Department of Emergency Medicine and SAMU-SMUR, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, 06001, Nice, France.
authors: Yassine
authors: Y
authors: Kabsy
authors: Department of Emergency Medicine and SAMU-SMUR, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, 06001, Nice, France.
authors: Nicolas
authors: N
authors: Fraimout
authors: Department of Emergency Medicine and SAMU-SMUR, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, 06001, Nice, France.
authors: Julie
authors: J
authors: Contenti
authors: Department of Emergency Medicine and SAMU-SMUR, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, 06001, Nice, France. levraut.j@chu-nice.fr.
authors: Jacques
authors: J
authors: Levraut
keywords: Medical resuscitation; Out-of-hospital cardiac arrest; Termination of resuscitation rule