A comparison of the universal TOR Guideline to the absence of prehospital ROSC and duration of resuscitation in predicting futility from out-of-hospital cardiac arrest

作者：Drennan Ian R^*; Case Erin; Verbeek P Richard; Reynolds Joshua C; Goldberger Zachary D; Jasti Jamie; Charleston Mark; Herren Heather; Idris Ahamed H; Leslie Paul R; Austin Michael A; Xiong Yan; Schmicker Robert H; Morrison Laurie J

来源：Resuscitation, 2017, 111: 96-102.

DOI：10.1016/j.resuscitation.2016.11.021

• Heart arrest
• Cardiopulmonary resuscitation
• Emergency Medical Services

Introduction: 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.
Objective: 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.
Design: Retrospective, observational cohort study.
Participants: Non-traumatic, adult (>= 18 years) OHCA patients of presumed cardiac etiology treated by EMS providers.
Setting: ROC-PRIMED and ROC-Epistry post ROC-PRIMED databases between 2007 and 2011.
Outcomes: 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.
Results: 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 aROSC after extended durations of CPR.
Conclusion: Using absence of ROSC as a sole predictor of futility misses potential survivors. The UniversalTOR Guideline remains a strong predictor of survival.

• 出版日期2017-2
• 单位河北医科大学