| Abstrakt: |
BackgroundAnnually in South West England 3,500 people receive a resuscitation attempt following an out-of-hospital cardiac arrest (OHCA). Paramedics use Termination of Resuscitation (TOR) guidelines to identify patients no longer benefiting from further resuscitation. This facilitates a dignified death and enables resource deployment to other patients. Historically, TOR was only supported for patients who remained continuously asystolic for 20 mins, however, the impact this guidance had on total resuscitation duration was unknown.MethodsThis retrospective registry-based evaluation reviewed adult OHCA cases between 1st April 2016 – 31st March 2022. OHCA witnessed by ambulance personnel were excluded along with cases containing missing time, demographic, or outcome data. Patients who re-arrested following return of spontaneous circulation (ROSC) were excluded. Resuscitation Duration (RD) was calculated as the time between the arrival of the first ambulance resource to either ROSC or TOR. Routinely collected 30-day survival data was included in the evaluation.Results13,092 cases were eligible for analysis. 9,392 patients received prehospital TOR (median RD 34.50mins) whilst 3,700 achieved ROSC (median RD 20.10 mins), 861 patients survived to 30-days (median RD 12.17 mins). A total of 7,989 patients presented with an initial rhythm of asystole, 6,701 of these patients had TOR (median RD 34.5 mins) whilst 1,288 achieved ROSC (median RD 23.33 mins), only 49 asystole patients survived to 30-days (0.6%). 24.0% of the sample (n=3,144) presented in a shockable rhythm, 1,517 of these patients had TOR (median RD 42.85 mins) whilst 22.5% (n=708) survived to 30-days (median RD 14.73 mins)ConclusionExisting TOR guidance delivers resuscitation for greater than 30mins to most patients, regardless of initial presenting rhythm. Resuscitation attempts ending in TOR exceed the average duration needed to achieve ROSC for patient who survive to 30-days. This evaluation suggests that total resuscitation duration could be considered in future TOR guidance, irrespective of presenting or continuous arrythmia. |
