Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest

Mark H. Ebell, Akke Vellinga, Siobhan Masterson, Phillip Yun

Research output: Contribution to journalArticle

Abstract

Background Our objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA). Methods We performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R. Results We identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95% for the European Resuscitation Council (ERC) TORR, 97% for the basic life support (BLS) TORR and 99% for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13% (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5% and 74.8%, respectively) than for the ALS TORR (29.0%). Conclusions The BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1%). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.

Original languageEnglish (US)
Pages (from-to)479-484
Number of pages6
JournalEmergency Medicine Journal
Volume36
Issue number8
DOIs
StatePublished - Jan 1 2019

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Out-of-Hospital Cardiac Arrest
Resuscitation
Meta-Analysis
Survivors

Keywords

  • cardiac arrest
  • emergency ambulance systems
  • resuscitation

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest. / Ebell, Mark H.; Vellinga, Akke; Masterson, Siobhan; Yun, Phillip.

In: Emergency Medicine Journal, Vol. 36, No. 8, 01.01.2019, p. 479-484.

Research output: Contribution to journalArticle

Ebell, Mark H. ; Vellinga, Akke ; Masterson, Siobhan ; Yun, Phillip. / Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest. In: Emergency Medicine Journal. 2019 ; Vol. 36, No. 8. pp. 479-484.
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abstract = "Background Our objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA). Methods We performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R. Results We identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95{\%} for the European Resuscitation Council (ERC) TORR, 97{\%} for the basic life support (BLS) TORR and 99{\%} for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13{\%} (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5{\%} and 74.8{\%}, respectively) than for the ALS TORR (29.0{\%}). Conclusions The BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1{\%}). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.",
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