Out-of-hospital cardiac arrest termination of resuscitation with ongoing CPR: An observational study

<p>Introduction: Termination of resuscitation guidelines for out-of-hospital cardiac arrest can identify patients inwhom continuing resuscitation has little chance of success. This study examined the outcomes of patientstransferred to hospital with ongoing CPR. It assessed outcomes for those who would have met the universalprehospital termination of resuscitation criteria (no shocks administered, unwitnessed by emergency medicalservices, no return of spontaneous circulation).Methods: A retrospective cohort study of consecutive adult patients who were transported to hospital withongoing CPR was conducted at three hospitals in the West Midlands, UK between September 2016 andNovember 2017. Patient characteristics, interventions and response to treatment (ROSC, survival to discharge)were identified.Results: 227 (median age 69 years, 67.8% male) patients were identified. 89 (39.2%) met the universal prehospitaltermination of resuscitation criteria. Seven (3.1%) were identified with a potentially reversible cause ofcardiac arrest. After hospital arrival, patients received few specialist interventions that were not available in theprehospital setting. Most (n=210, 92.5%) died in the emergency department. 17 were admitted (14 to intensivecare), of which 3 (1.3%) survived to hospital discharge. There were no survivors (0%) in those who met thecriteria for universal prehospital termination of resuscitation.Conclusion: Overall survival amongst patients transported to hospital with ongoing CPR was very poor.Application of the universal prehospital termination of resuscitation rule, in patients without obvious reversiblecauses of cardiac arrest, would have allowed resuscitation to have been discontinued at the scene for 39.2% ofpatients who did not survive.</p>