Takeaway
- After out-of-hospital cardiac arrest (OHCA), a simple decision rule could reduce futile attempts at resuscitation.
- The rule resembles another that was recently validated.
- Authors suggest pursuing resuscitation if patient age is unknown.
- Validation studies needed.
Why this matters
- Resuscitation and transportation are costly and put providers and bystanders at risk.
- When patients survive to hospital admission but die shortly thereafter, families suffer emotionally and financially.
- No widely accepted guideline helps providers decide which arrest resuscitations are futile.
Key results
- A 3-item rule was 100% specific for arrests that did not survive to discharge (n=223):
- Patients age ≥80 years.
- Unwitnessed arrest.
- Nonshockable initial rhythm.
- Authors suggest acronym “NUE”: Nonshockable initial rhythm, Unwitnessed, Eighty or older.
- Another rule was 100% specific for arrests that did not survive with good neurological outcome (n=296):
- Patients age ≥80 years.
- Arrest at home.
- Nonshockable initial rhythm.
Study design
- Retrospective cohort study of 4 years of paramedic-attended cardiac arrests in a California county, recorded in Cardiac Arrest Registry to Enhance Survival database (n=1706).
- Based on characteristics of patients, arrests, and emergency response, authors developed rule to predict resuscitation futility.
- Funding: None disclosed.
Limitations
- Single-system study without validation cohort.
References
References