Another busy TCC day is interrupted by an EMT phone call from a BLS pumper with Northeast Fire Protection District. They have arrived on the scene of an 88 year old female “found down” by family with unknown downtime. Per EMT, she was apneic and pulseless upon their arrival with no signs of obvious death (rigor mortis, lividity, etc.). A family member has begun CPR. The EMT and fire fighters continue CPR and attach the AED which advises no shock. They have done approximately 10 minutes of CPR thus far. Unfortunately, both of Northeast’s ambulances are unavailable. One has just arrived on the scene of a nearby MVC with entrapment. The EMT surmises that the patient is likely deceased and would like to terminate resuscitation. Do you direct them to continue resuscitation or to terminate all efforts and proceed to the MVC?
Uncertain, you advise them to continue resuscitative efforts. Only minutes later, you receive another call from the same scene. An ALS ambulance from Gateway Ambulance has arrived and notes that the patient remains apneic and pulseless with asystole on the monitor. The paramedic would now like you to terminate the resuscitation so that all parties may go back into service. Should they continue resuscitation and transport to the ED, or may they return to service?
You are now so intrigued by all aspects of EMS and prehospital care that you forego the usual after-shift beers so you can go directly to the library for an exciting literature search.
Search Strategy: An Ovid search combining the key words “emergency medical services”, “cardiopulmonary resuscitation”, and “termination” on Jan 8, 2009 yields 56 responses from which four significant articles are selected.
Population: Pre-hospital, non-traumatic arrest victims
Intervention: Application of termination of resuscitation score by BLS or ALS pre-hospital personnel
Comparison: Routine pre-hospital care
Outcome: Prognostic accuracy for neurologically intact hospital
First Years: Derivation of a Termination-of-Resuscitation Guideline for Emergency Medical Technicians Using Automated External Defibrillators, Acad Emerg Med 2002; 9: 671-678.
Second Years: Validation of a Rule for Termination of Resuscitation in Out-of-Hospital Cardiac Arrest, NEJM 2006; 355: 478-487. (http://pmid.us/16885551)
Third Years: Derivation and Evaluation of a Termination of Resuscitation Clinical Prediction Rule for Advanced Life Support Providers, Resuscitation 2007 74: 266-275. (http://pmid.us/17383072)
Fourth Years: Prehospital Termination of Resuscitation in Cases of Refractory Out-of-Hospital Cardiac Arrest, JAMA 2008; 300: 1432-1438. (http://pmid.us/18812534)
Article 1 Answer Key -PGY-I ANSWER KEY - Derivation of a Termination-of-resuscitation Guideline for Emergency Medical Technicians Using Automated External Defibrillators, Acad Emerg Med 2002; 9: 671-678
Transport to the ED if any of the following pre-hospital findings are noted in suspected cardiac arrest: