title: Out-of-hospital cardiac arrest without return of spontaneous circulation in the field: Who are the survivors?
abstract: Return of spontaneous circulation (ROSC) in the field is a vital determinant contributing to survival from out-of-hospital cardiac arrest (OHCA). However, nearly one third of survivors at the Dallas-Fort Worth (DFW) Resuscitation Outcomes Consortium (ROC) site did not obtain ROSC in the field.
  
  
  
  A retrospective, observational analysis was performed on all adult patients with non-traumatic OHCA treated on scene and transported to hospital, who did not gain ROSC in the field at DFW ROC site between 2006 through 2011.We described the demographics, pre-hospital characteristics and outcomes of all enrolled cases. Those patients without ROSC in the field, who did and did not meet Termination of Resuscitation (TOR) criteria in the field, were also compared.
  
  
  
  Among a total of 5099 treated and transported non-traumatic OHCA cases, 83.2% (4243) were included in this study as patients without ROSC gained in the field, of which 66.6% (2827) met TOR criteria but still were treated and transported; 1.9% (79) survived to hospital discharge. Further analysis showed that 39.2% (31) of survivors met TOR rule, accounting for 1.1% of those patients who should have been declared dead in the field. Shockable initial rhythms, EMS-witnessed arrest, bystander CPR and age were factors significant to predict survival from OHCA without ROSC in the field. Of concern, 1.7% (47) of patients who met TOR presented initially shockable rhythms but no shocks were delivered in the field.
  
  
  
  We suggest that all treated non-traumatic OHCA patients should be transported to hospital.
authors.affiliation: Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China; Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA. Electronic address: xiongyan@mail.sysu.edu.cn.
authors.forename: Yan
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhan
authors.affiliation: Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China; Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA.
authors.forename: Yuanzheng
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
authors.forename: Kaipan
authors.initials: K
authors.lastname: Guan
authors.affiliation: Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA.
authors.forename: Ngozi
authors.initials: N
authors.lastname: Okoro
authors.affiliation: Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Mitchell
authors.affiliation: Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Dwyer
authors.affiliation: Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA.
authors.forename: Auna
authors.initials: A
authors.lastname: Leatham
authors.affiliation: Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Salazar
authors.affiliation: Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
authors.forename: Xiaoxing
authors.initials: X
authors.lastname: Liao
authors.affiliation: Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA. Electronic address: aidris@sbcglobal.net.
authors.forename: Ahamed
authors.initials: A
authors.lastname: Idris
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001775:Blood Circulation; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Cardiac arrest; Outcomes; Return of spontaneous circulation; Termination of Resuscitation