First responders are tasked with doing everything in their power to save people’s lives. Unfortunately, they must sometimes make the challenging decision to stop resuscitation.
However, a new study suggests that the current guidelines for stopping resuscitation in cardiac arrest victims don’t have enough evidence to distinguish who will survive and who won’t.
“Our findings suggest that [termination of resuscitation] rules may miss substantial numbers of survivors,” the researchers wrote in their study.
In a systematic review and meta-analysis published Wednesday in JAMA Network Open, researchers and physicians in the United Kingdom, Europe, and the United States evaluated 43 studies published over the past 30 years, examining more than 1 million cases.
They found the Termination of Resuscitation (TOR) rules lacked the ability “to discriminate between those patients who will die and those who will survive.
“Adoption of TOR rules may lead to missed survivors and increased resource utilization,” the authors concluded.
7 Guidelines Evaluated
The researchers evaluated seven different guidelines for termination of resuscitation: advanced life support (ALS), basic life support (BLS), the universal termination of resuscitation rule (UTOR), and Marsden, Petrie, Shibahashi 1, and Goto 1 TOR rules.
The authors evaluated each guideline for its ability to distinguish survivors from non-survivors.
The Petrie and ALS rules failed to reach acceptable standards, whereas both BLS and Shibahashi 1 achieved acceptable performance. The UTOR, Marsden, and Goto 1 rules performed excellently, with UTOR and Goto 1 being the best.
The authors found that BLS had the potential to miss more than 1 percent of survivors, while the other guidelines could miss up to 1 percent of survivors.
The other guidelines that performed poorly may increase the likelihood that the incorrect decision to transport the patient is made, even if unnecessary. The authors also observed that adhering to the ALS rules favors transporting the patient, even though research has shown that transporting a patient during resuscitation is associated with a reduced probability of survival.
No Federal Guidelines in the US
The U.S. government does not regulate TOR rules.
However, the American Heart Association endorses ALS and BLS TOR rules, though these endorsements are not official since it is up to each state to develop its own protocol for emergency medical services personnel.
According to the ALS, emergency medical personnel should terminate resuscitation if:
- No shock is delivered
- The cardiac arrest was not witnessed by EMS personnel or a bystander
- Bystanders provided no CPR
- There is no return of spontaneous circulation prior to transport
The BLS has the same requirements except for the last.
The researchers concluded that there is minimal evidence that current TOR rules can discriminate between patients who will die and those who will survive. They wrote that clinical studies on the effectiveness of the resuscitation rules are almost nonexistent.
“In addition, futile transport is not consistent with evidence-based practice; it reduces the likelihood of survival, increases risk, consumes scarce emergency department resources, and incurs substantial avoidable costs. Therefore, we suggest that there is an urgent need to review the role of TOR rules.”