医学
自然循环恢复
指南
复苏
心肺复苏术
急诊医学
回顾性队列研究
紧急医疗服务
急诊科
队列
重症监护医学
内科学
病理
护理部
作者
Ian R. Drennan,Erin Case,P. Richard Verbeek,Joshua C. Reynolds,Zachary D. Goldberger,Jamie Jasti,Mark Charleston,Heather Herren,Ahamed H. Idris,Paul Leslie,M Austin,Yan Xiong,Robert H. Schmicker,Laurie J. Morrison
出处
期刊:Resuscitation
[Elsevier]
日期:2017-02-01
卷期号:111: 96-102
被引量:45
标识
DOI:10.1016/j.resuscitation.2016.11.021
摘要
The Universal Termination of Resuscitation (TOR) Guideline accurately identifies potential out-of-hospital cardiac arrest (OHCA) survivors. However, implementation is inconsistent with some Emergency Medical Service (EMS) agencies using absence of return of spontaneous circulation (ROSC) as sole criterion for termination.To compare the performance of the Universal TOR Guideline with the single criterion of no prehospital ROSC. Second, to determine factors associated with survival for patients transported without a ROSC. Lastly, to compare the impact of time to ROSC as a marker of futility to the Universal TOR Guideline.Retrospective, observational cohort study.Non-traumatic, adult (≥18 years) OHCA patients of presumed cardiac etiology treated by EMS providers.ROC-PRIMED and ROC-Epistry post ROC-PRIMED databases between 2007 and 2011.Primary outcome was survival to hospital discharge and the secondary outcome was functional survival. We used multivariable regression to evaluate factors associated with survival in patients transported without a ROSC.36,543 treated OHCAs occurred of which 9467 (26%) were transported to hospital without a ROSC. Patients transported without a ROSC who met the Universal TOR Guideline for transport had a survival of 3.0% (95% CI 2.5-3.4%) compared to 0.7% (95% CI 0.4-0.9%) in patients who met the Universal TOR Guideline for termination. The Universal TOR Guideline identified 99% of survivors requiring continued resuscitation and transportation to hospital including early identification of survivors who sustained a ROSC after extended durations of CPR.Using absence of ROSC as a sole predictor of futility misses potential survivors. The Universal TOR Guideline remains a strong predictor of survival.
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