• Alexander T Limkakeng, Jinny J Ye, Catherine Staton, Yih Yng Ng, LeongBenjamin S HBSHEmergency Medicine Department, National University Hospital, Singapore., Nur Shahidah, Muhammad Yazid, Alexander Gordee, Maragatha Kuchibhatla, OngMarcus E HMEHHealth Services and Systems Research, Duke-National University of Singapore Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore., and Singapore PAROS Investigators.
• Duke University Emergency Medicine, Duke University, Durham, NC 27710, USA.
• Resuscitation. 2022 Jan 1; 170: 160166160-166.

BackgroundCurrent Advanced Life Support Termination of Resuscitation (TOR) guidelines suggest when to cease cardiopulmonary resuscitation (CPR). With the significant increase of Dispatch-Assisted CPR (DA-CPR) programs, the impact of DA-CPR on the TOR criteria performance is not clear.MethodsWe conducted a secondary analysis of a prospectively collected registry, the Pan-Asian Resuscitation Outcomes Study. We included patients >15 years old with out-of-hospital cardiac arrest between 2014 and 2017 (after implementation of Singapore's DA-CPR program). We excluded patients with non-cardiac etiology, known do-not-resuscitate status, and healthcare provider bystanders. All cases were collected in accordance to Utstein standards. We evaluated the addition of DA-CPR to the diagnostic performance of TOR criteria using logistic regression modeling. The primary outcome was performance for predicting non-survival at 30 days. Sensitivity, specificity, and positive and negative predictive values were calculated.ResultsOf the 6009 cases, 319 (5.3%) were still alive at 30 days. Patients had a mean age of 67.9 (standard deviation 15.7) years and were mostly male and Chinese. Almost half of patients had no bystander CPR. The TOR criteria differentiating DA-CPR from unassisted bystander CPR has a specificity of 94% and predictive value of death of 99%, which was not significantly different from undifferentiated CPR criteria. There were differences in adjusted association with survival between unassisted and DA-CPR.ConclusionAdvanced life support TOR criteria retain high specificity and predictive value of death in the context of DA-CPR. Further research should explore the differences between unassisted CPR and DA-CPR to understand differential survival outcomes.Copyright © 2021 Elsevier B.V. All rights reserved.

15 keywords...

hide…