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Cited by 6Cardiac Arrest and ResuscitationPalliative Care and End-of-Life IssuesEmergency and Acute Care Studies

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Evaluation of the Uptake of a Prehospital Cardiac Arrest Termination of Resuscitation Rule

Teefy, John, Cram, Natalie, Van Zyl, Theunis, Van Aarsen, Kristine, McLeod, Shelley, Dukelow, Adam·2020·The Journal of Emergency Medicine
DOI 10.1016/j.jemermed.2019.11.018
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Abstract

Background Previous research has focused on creation and validation of a basic life support rule for termination of resuscitation (TOR) in nontraumatic out-of-hospital cardiac arrest (OHCA) to identify patients who will not be successfully resuscitated or will not have a favorable outcome. Although now widely implemented, translational research regarding in-field compliance with TOR criteria and barriers to use is scarce. Objectives This project aimed to assess compliance rates, barriers to use, and effect on ambulance transport rates after implementing TOR criteria for OHCA. Methods Retrospective chart review of patients ≥ 18 years with OHCA. Data from regional Emergency Medical Services agencies were collected to determine TOR rule compliance for patients meeting criteria, barriers to use, and effect of a TOR rule on ambulance transport. Results There were 552 patients with OHCAs identified. Ninety-one patients met TOR criteria, with paramedics requesting TOR in 81 (89%) cases and physicians granting requests in 65 (80.2%) cases. Perceived barriers to TOR compliance included distraught families, nearby advanced-care paramedics, and unusual circumstances. Reasons for physician refusal of TOR requests included hospital proximity, patient not receiving epinephrine, and poor communication connection to paramedics. Total high priority transports decreased 15.6% after implementation of a TOR rule. Conclusions The study found high compliance after implementation of a TOR rule and identified potentially addressable barriers to TOR use. Appropriate application of a TOR rule led to reduction in high-priority ambulance transports, potentially reducing futile use of health care resources and risk of ambulance motor vehicle collisions.

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Crossref · 10.1016/j.jemermed.2019.11.018

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  • Decision-making regarding the withholding or termination of resuscitation exists in a legal framework, which will have primacy over ethical concepts.

    “Decision-making regarding the withholding or termination of resuscitation exists in a legal framework, which will have primacy over ethical concepts. 125”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [125]

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Research works printed but not linked: 20

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Metadata

Authors
Teefy, J., Cram, N., Van Zyl, T., Van Aarsen, K., McLeod, S., & Dukelow, A.
Affiliations
  • Western University (CA)
  • Alberta Health Services (CA)
  • University of Toronto (CA)
ORCID
Venue
The Journal of Emergency Medicine
Publisher
Elsevier BV
Published
2020-02
Volume
58
Issue
2
Pages
254-259
ISSN
0736-4679 (ISSN-L)
DOI
10.1016/j.jemermed.2019.11.018
OpenAlex
W2999806562
Cited by
6
References
0
Citations by year
2024: 1 · 2023: 3 · 2021: 2
FWCI
1.21
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Journal of Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
termination of resuscitation, out-of-hospital cardiac arrest, prehospital care, rule compliance, barriers to use, ambulance transport, paramedics, epinephrine, healthcare resource utilization
MeSH terms
Aged, Ambulances, Decision Support Techniques, Emergency Medical Services, Female, Humans, Male, Middle Aged, Ontario, Retrospective Studies, Cardiopulmonary Resuscitation, Medical Futility, Out-of-Hospital Cardiac Arrest

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