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Association: Name: National Association of EMS Physicians URL: http://www.naemsp.org
Citation: URL: http://www.allacademic.com/meta/p55845_index.html Direct Link: HTML Code:

Morrison, Laurie., Visentin, Laura. and Verbeek, P. Richard. "Prospective validation of a termination of resuscitation guideline for defibrillation-trained Emergency Medical Technicians" Paper presented at the annual meeting of the National Association of EMS Physicians, Registry Resort, Naples, FL, <Not Available>. 2009-05-25 <http://www.allacademic.com/meta/p55845_index.html>

Morrison, L. , Visentin, L. and Verbeek, P. "Prospective validation of a termination of resuscitation guideline for defibrillation-trained Emergency Medical Technicians" Paper presented at the annual meeting of the National Association of EMS Physicians, Registry Resort, Naples, FL <Not Available>. 2009-05-25 from http://www.allacademic.com/meta/p55845_index.html

Publication Type: Abstract Abstract: OBJECTIVE: The objective of this study was to prospectively validate a previously derived Basic Life Support Termination of Resuscitation (BLS TOR) guideline for out-of-hospital cardiac arrest managed by defibrillation-trained Emergency Medical Technicians (EMT-D). The guideline supports termination in the out-of-hospital setting subsequent to failed basic life support resuscitation by EMT-D if all of the following are true: (1) no return of spontaneous circulation prior to transport; (2) no shock given prior to transport; and (3) arrest not witnessed by EMS personnel (firefighter or EMT-D). METHODS: This prospective validation study was conducted in 12 rural and urban communities in Ontario, Canada, involving 24 EMS systems. Patient care was unchanged during the study. Survival was measured as hospital discharge or in-hospital at 6 months. A t-test statistic compared the survival rate when the guideline suggested termination to the 1.0% rate of survivability reflective of medical futility. Diagnostic test characteristics of the guideline to predict survival were calculated. RESULTS: A total of 1240 cardiac arrest cases were enrolled over the 25 month study period, with 100% follow-up. The survival rate when the guideline indicated termination was 4 out of 776 or 0.5% (95% CI, 0.1%, 0.9%), significantly less than the medical futility rate of 1.0% (p = 0.04). The BLS TOR guideline was 90% (95% CI, 88%, 92%) sensitive in identifying survivors; had a specificity of 64% (95% CI, 62%, 67%), a positive predictive value of 8% (95% CI, 7%, 10%), and a negative predictive value of 99% (95% CI, 99%, 100%). CONCLUSIONS: The BLS TOR guideline suggested termination with a survival rate below that considered to be medically futile and had a strong negative predictive value for survival. The guideline is a valid means to identify patients who could be considered for out-of-hospital termination of resuscitation following failed basic life support resuscitation by EMT-D.

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