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    Reducing the futile transportation of out-of-hospital cardiac arrests: a retrospective validation

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    Author
    House, Matthew
    Gray, Joanne
    McMeekin, Peter
    Keyword
    Emergency Medical Services
    Prediction Tool
    Resuscitation
    Out-of-Hospital Cardiac Arrest (OHCA)
    Journal title
    British Paramedic Journal
    
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    URI
    http://hdl.handle.net/20.500.12417/166
    DOI
    10.29045/14784726.2018.09.3.2.1
    Abstract
    Abstract published with permission. Objectives: The primary aim was to measure the predictive value of a termination of resuscitation guideline that allows for pre-hospital termination of adult cardiac arrests of presumed cardiac aetiology where the patient did not present in a shockable cardiac rhythm and did not achieve return of spontaneous circulation on-scene. The secondary objective was to compare the effectiveness of that guideline with existing basic life support and advanced life support guidelines. Methods: A retrospective review of 2139 adult out-of-hospital primary cardiac arrest patients transported to hospital by a single ambulance trust during a 12-month period between 1 April 2014 and 31 March 2015. Results: Application of the new guideline identified 832 for termination, from which three (0.4%) survived, resulting in a specificity of 99.1% (95% CI: 97.4% to 99.8%), PPV of 99.6% (95% CI: 99% to 99.9%), sensitivity of 46.5% (95% CI: 44.1% to 48.8%) and NPV of 25.6% (95% CI: 23.2% to 28.1%). The transport rate was 60.7%, compared to 72.8% for the basic life support guideline and 95.2% for the advanced life support guideline. Conclusions: Within the tested cohort, a reduction of 39.3% in transport of adult out-of-hospital primary cardiac arrest of presumed cardiac aetiology could have been achieved if using a termination of resuscitation guideline that allows for termination on-scene when the patient presented in a non-shockable rhythm and there has been no return of spontaneous circulation. These guidelines require prospective validation, but may identify more futile transportations than other previously validated guidelines.
    ae974a485f413a2113503eed53cd6c53
    10.29045/14784726.2018.09.3.2.1
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