TY - JOUR
T1 - A New Rule for Terminating Resuscitation of Out-of-Hospital Cardiac Arrest Patients in Japan
T2 - A Prospective Study
AU - SOS-KANTO 2012 study group
AU - Inokuchi, Sadaki
AU - Masui, Yoshihiro
AU - Miura, Kunihisa
AU - Tsutsumi, Haruhiko
AU - Takuma, Kiyotsugu
AU - Atsushi, Ishihara
AU - Nakano, Minoru
AU - Tanaka, Hiroshi
AU - Ikegami, Keiichi
AU - Arai, Takao
AU - Yaguchi, Arino
AU - Kitamura, Nobuya
AU - Oda, Shigeto
AU - Kobayashi, Kenji
AU - Suda, Takayuki
AU - Ono, Kazuyuki
AU - Morimura, Naoto
AU - Furuya, Ryosuke
AU - Koido, Yuichi
AU - Iwase, Fumiaki
AU - Nagao, Ken
AU - Kanesaka, Shigeru
AU - Okada, Yasusei
AU - Unemoto, Kyoko
AU - Sadahiro, Tomohito
AU - Iyanaga, Masayuki
AU - Muraoka, Asaki
AU - Hayashi, Munehiro
AU - Ishimatsu, Shinichi
AU - Miyake, Yasufumi
AU - Yokokawa, Hideo
AU - Koyama, Yasuaki
AU - Tsuchiya, Asuka
AU - Kashiyama, Tetsuya
AU - Hayashi, Munetaka
AU - Oshima, Kiyohiro
AU - Kiyota, Kazuya
AU - Hamabe, Yuichi
AU - Yokota, Hiroyuki
AU - Hori, Shingo
AU - Inaba, Shin
AU - Sakamoto, Tetsuya
AU - Harada, Naoshige
AU - Kimura, Akio
AU - Kanai, Masayuki
AU - Otomo, Yasuhiro
AU - Sugita, Manabu
AU - Kinoshita, Kosaku
AU - Sakurai, Takatoshi
AU - Kobe, Yoshiro
N1 - Publisher Copyright:
© 2017 The Authors
PY - 2017/9
Y1 - 2017/9
N2 - Background The American Heart Association and European Resuscitation Council guidelines for cardiopulmonary resuscitation present rules for termination of resuscitation (TOR) in cases of out-of-hospital cardiac arrest (OHCA). In Japan, only doctors are legally allowed TOR in OHCA cases. Objective This study aimed to develop a new TOR rule that suits the actual situations of the Japanese emergency medical services system. Methods Five different combinations of the TOR rule criteria were compared regarding specificity and positive predictive value (PPV) for 1-month survival with unfavorable neurologic outcomes. The criteria were unwitnessed by emergency medical service personnel, unwitnessed by bystanders, initial unshockable rhythm in the field, initial asystole in the field, no shock delivered, no prehospital return of spontaneous circulation, unshockable rhythm at hospital arrival, and asystole at hospital arrival. Results A total of 13,291 cases were included. The following combination provided the highest specificity and PPV for predicting 1-month unfavorable neurologic outcomes and death: unwitnessed by bystanders, initial asystole in the field, and asystole at hospital arrival. The specificity and PPV for the combination of the three criteria for predicting 1-month unfavorable neurologic outcomes were 0.992 and 0.999, and for predicting death at 1 month after OHCA were 0.986 and 0.998, respectively. Conclusions OHCA patients fulfilling the criteria unwitnessed by bystanders and asystole in the field and at hospital arrival had universally poor outcomes. Termination of resuscitation after hospital arrival for these patients may decrease unwarranted treatments.
AB - Background The American Heart Association and European Resuscitation Council guidelines for cardiopulmonary resuscitation present rules for termination of resuscitation (TOR) in cases of out-of-hospital cardiac arrest (OHCA). In Japan, only doctors are legally allowed TOR in OHCA cases. Objective This study aimed to develop a new TOR rule that suits the actual situations of the Japanese emergency medical services system. Methods Five different combinations of the TOR rule criteria were compared regarding specificity and positive predictive value (PPV) for 1-month survival with unfavorable neurologic outcomes. The criteria were unwitnessed by emergency medical service personnel, unwitnessed by bystanders, initial unshockable rhythm in the field, initial asystole in the field, no shock delivered, no prehospital return of spontaneous circulation, unshockable rhythm at hospital arrival, and asystole at hospital arrival. Results A total of 13,291 cases were included. The following combination provided the highest specificity and PPV for predicting 1-month unfavorable neurologic outcomes and death: unwitnessed by bystanders, initial asystole in the field, and asystole at hospital arrival. The specificity and PPV for the combination of the three criteria for predicting 1-month unfavorable neurologic outcomes were 0.992 and 0.999, and for predicting death at 1 month after OHCA were 0.986 and 0.998, respectively. Conclusions OHCA patients fulfilling the criteria unwitnessed by bystanders and asystole in the field and at hospital arrival had universally poor outcomes. Termination of resuscitation after hospital arrival for these patients may decrease unwarranted treatments.
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U2 - 10.1016/j.jemermed.2017.05.025
DO - 10.1016/j.jemermed.2017.05.025
M3 - Article
C2 - 28843461
AN - SCOPUS:85028321829
SN - 0736-4679
VL - 53
SP - 345
EP - 352
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 3
ER -