• Resuscitation · Jul 2023

    Quantifying physician's bias to terminate resuscitation. The TERMINATOR Study.

    • T Laurenceau, Q Marcou, J M Agostinucci, L Martineau, J Metzger, P Nadiras, J Michel, T Petrovic, F Adnet, and F Lapostolle.
    • SAMU 93, UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942. Hôpital Avicenne, APHP, 125, rue de Stalingrad, 93009 Bobigny, France. Electronic address: thomas.laurenceau@gmail.com.
    • Resuscitation. 2023 Jul 1; 188: 109818109818.

    ContextDeciding on "termination of resuscitation" (TOR) is a dilemma for any physician facing cardiac arrest. Due to the lack of evidence-based criteria and scarcity of the existing guidelines, crucial arbitration to interrupt resuscitation remains at the practitioner's discretion.AimEvaluate with a quantitative method the existence of a physician internal bias to terminate resuscitation.MethodWe extracted data concerning OHCAs managed between January 2013 and September 2021 from the RéAC registry. We conducted a statistical analysis using generalized linear mixed models to model the binary TOR decision. Utstein data were used as fixed effect terms and a random effect term to model physicians personal bias towards TOR.Results5,144 OHCAs involving 173 physicians were included. The cohort's average age was 69 (SD 18) and was composed of 62% of women. Median no-flow and low-flow times were respectively 6 (IQR [0,12]) and 18 (IQR [10,26]) minutes. Our analysis showed a significant (p < 0.001) physician effect on TOR decision. Odds ratio for the "doctor effect" was 2.48 [2.13-2.94] for a doctor one SD above the mean, lower than that of dependency for activities of daily living (41.18 [24.69-65.50]), an age of more than 85 years (38.60 [28.67-51.08]), but higher than that of oncologic, cardiovascular, respiratory disease or no-flow duration between 10 to 20 minutes (1.60 [1.26-2.00]).ConclusionsWe demonstrate the existence of individual physician biases in their decision about TOR. The impact of this bias is greater than that of a no-flow duration lasting ten to twenty minutes. Our results plead in favor developing tools and guidelines to guide physicians in their decision.Copyright © 2023. Published by Elsevier B.V.

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