Implementation trial of the basic life support termination of resuscitation rule: Reducing the transport of futile out-of-hospital cardiac arrests
| Autor: | Jim Scott, Precilla V. Veigas, Alex Kiss, Cathy Prowd, P. Richard Verbeek, Chris Loreto, Erica Reichl, Don Eby, Tim Waite, Vince Arcieri, Marty Pilkington, Tim Dodd, Laurie J. Morrison, Jeanette M. Verdon, Jason E. Buick, Paul Hoogeveen, Michelle Welsford, Elma Mooney, Cathy Zhan |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Resuscitation Attitude of Health Personnel medicine.medical_treatment education Emergency Nursing Return of spontaneous circulation Decision Support Techniques Clinical Protocols Physicians medicine Emergency medical services Humans Prospective Studies Cardiopulmonary resuscitation Intensive care medicine Aged Resuscitation Orders Aged 80 and over Out of hospital Termination of resuscitation business.industry Patient Selection Basic life support Middle Aged Cardiopulmonary Resuscitation Life Support Care Emergency Medical Technicians Transportation of Patients Emergency Medicine Female Guideline Adherence Historical control Cardiology and Cardiovascular Medicine business Medical Futility Out-of-Hospital Cardiac Arrest |
| Zdroj: | Resuscitation. 85:486-491 |
| ISSN: | 0300-9572 |
| DOI: | 10.1016/j.resuscitation.2013.12.013 |
| Popis: | The basic life support (BLS) termination of resuscitation (TOR) rule recommends transport and continued resuscitation when cardiac arrest is witnessed by EMT-Ds, or there is a return of spontaneous circulation, or a shock is given, and prior studies have suggested the transport rate should fall to 37%.This real-time prospective multi-center implementation trial evaluated the BLS TOR rule for compliance, transport rate and provider and physician comfort. Both provider and physician noted their decision-making rationale and ranked their comfort on a 5-point Likert scale. Functional survival was measured at discharge. Of 2421 cardiac arrests, 953 patients were eligible for the rule, which was applied correctly for 755 patients (79%) of which 388 were terminated. 565 patients were transported resulting in a reduction of the transport rate from 100% (historical control) to 59% (p0.001). The BLS TOR rule was not followed in 198 eligible patients (21%) and they were all transported despite meeting the criteria to terminate. Providers cited 241 reasons for non-compliance: family distress, short transport time interval, younger age and public venue. All 198 transported patients, non-compliant with the rule, died. Both providers and physicians were comfortable with using the rule to guide TOR (median [IQR] of 5 [4,5]; p0.001).This implementation trial confirmed the accuracy of the BLS TOR rule in identifying futile out-of-hospital cardiac arrest (OHCA) resuscitations, significantly reduced the transport rate of futile OHCA and most providers and physicians were comfortable following the rule's recommendations. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect