Validation of 3 Termination of Resuscitation Criteria for Good Neurologic Survival After Out-of-Hospital Cardiac Arrest
Received 5 August 2008; received in revised form 3 November 2008; accepted 12 November 2008. published online 22 January 2009.
Study objective
Several termination of resuscitation criteria have been proposed to identify patients who will not survive to hospital discharge after out-of-hospital cardiac arrest. However, only 1 set has been derived to specifically predict survival to hospital discharge with good neurologic function. The objectives of this study were to externally validate the basic life support (BLS) termination of resuscitation, advanced life support (ALS) termination of resuscitation, and neurologic termination of resuscitation criteria and compare their abilities to predict survival to hospital discharge with good neurologic function after out-of-hospital cardiac arrest.
Methods
This was a secondary analysis of the Denver Cardiac Arrest Registry. Consecutive adult nontraumatic cardiac arrest patients in Denver County from January 1, 2003, through December 31, 2004, were included in the study. The BLS termination of resuscitation, ALS termination of resuscitation, and neurologic termination of resuscitation criteria were applied to the cohort, and their predictive proportions and 95% confidence intervals (CIs) were calculated for each set of criteria.
Results
Of the 715 patients included in this study, the median age was 65 years (interquartile range 52 to 78 years), and 69% were male patients. In addition, 223 (31%) had return of spontaneous circulation, 175 (24%) survived to hospital admission, 58 (8%) survived to hospital discharge, and 42 (6%) survived to hospital discharge with good neurologic function. The proportion of patients with good neurologic survival to hospital discharge correctly identified for continued resuscitation was 100% (95% CI 92% to 100%) for all 3 termination of resuscitation criteria. The proportion of patients with poor neurologic survival to hospital discharge or no survival to hospital discharge correctly identified as eligible for termination of resuscitation was 36% (95% CI 32% to 40%) with the BLS termination of resuscitation criteria, 25% (95% CI 22% to 29%) with the ALS termination of resuscitation criteria, and 6% (95% CI 4% to 8%) with the neurologic termination of resuscitation criteria. Use of the BLS termination of resuscitation criteria would have reduced transport of the largest number of patients.
Conclusion
All 3 termination of resuscitation criteria had equally high abilities to identify patients requiring continued resuscitation. The BLS termination of resuscitation criteria, however, had the best combined ability to predict good neurologic survival and poor neurologic survival or death. These findings and the relative simplicity of the BLS termination of resuscitation criteria support their use.
aUniversity of Colorado Denver School of Medicine, Aurora, CO
bDepartment of Emergency Medicine, Denver Health Medical Center, Denver, CO
cDepartment of Epidemiology, Colorado School of Public Health, Aurora, CO
Address for correspondence: Jason S. Haukoos, MD, MSc, Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO 80204; 303-436-7141, fax 303-436-7541
Supervising editors: Amy H. Kaji, MD, MPH, PhD; Donald M. Yealy, MD
Author contributions: MLR and JSH conceived and designed the study. JSH supervised data collection and management. JSH performed statistical analyses and all authors performed critical interpretation of the results. MLR drafted the manuscript and all authors contributed substantively to its revision. JSH takes responsibility for the article as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Supported in part by a Summer Research Training Grant from the University of Colorado Denver School of Medicine (Ruygrok) and an Independent Scientist Award (K02 HS017526) from the Agency for Healthcare Research and Quality (Haukoos).
Publication date: Available online January 21, 2009.
ABSTRACT