Sasson C et al. (2008) Prehospital termination of resuscitation in cases of refractory out-of-hospital cardiac arrest. JAMA 300: 1432–1438

Survival among patients who suffer an out-of-hospital cardiac arrest (OHCA) varies widely and often depends on whether resuscitation at the scene is successful. Identification of individuals unlikely to benefit from continued in-hospital resuscitation attempts could decrease resource use, reduce the costs and risks associated with emergency transport, and allow medical personnel to focus on patients who are most likely to survive.

Sasson et al. have retrospectively validated the basic life support (BLS) and advanced life support (ALS) rules used to identify patients with OHCA who are unlikely to benefit from in-hospital resuscitation. After an appropriate resuscitation effort at the scene, if the patient does not meet either the BLS or ALS criteria, resuscitation attempts should cease.

Data were analyzed from 5,505 patients who were treated for OHCA and included in the Cardiac Arrest Registry to Enhance Survival. Overall, 17.2% of OHCA patients were pronounced dead at the scene on the basis of standard protocols. Out-of-hospital resuscitation attempts would have been terminated in 47.1% and 21.7% of patients had the BLS or ALS rule, respectively, been applied. Although the BLS rule misclassified five individuals who would have met the criteria but actually survived to hospital discharge, it had an acceptable positive predictive value of 99.8%. None of the patients who met the ALS criteria survived and this rule, therefore, had a positive predictive value of 100%. The authors call for a prospective study to assess the use of BLS and ALS rules in clinical practice.