A Retrospective Analysis to Determine Criteria for Termination of Resuscitation (TOR) for a Patient with an Out-of-Hospital Cardiac Arrest (OHCA) who Presents at the Emergency Department (ED)

ABSTRACT

PURPOSE: As public awareness of medical futility increases, more studies on pronouncement of death and related protocols in the field have been conducted overseas. However, it appears to be hard to declare death in the field in Korea due to a lack of proper treatment procedures for patients with out-of-hospital cardiac arrest (OHCA) under the current emergency medical service (EMS) system. As such, the objective of this study was to establish criteria to determine whether to perform cardiopulmonary resuscitation (CPR) for a patient who visits the ED with OHCA. METHODS: CPR results over an 8-year period, from January 2001 to December 2008, from patients with OHCA at Ewha Womans University, Mokdong Hospital were analyzed. The main factors affecting patients that survived for 24 hours after return of spontaneous circulation (ROSC) were identified retrospectively. RESULTS: A total of 782 patients visited the hospital due to OHCA during the study period. Of these, 752 met the inclusion criteria for our study. Of the 752, 162 (21.5%) survived over 24 hours after ROSC. Of the 752, 38 (5.1%) survived to hospital discharge and 18 (2.4%) survived to hospital discharge with good neurologic function. Among patients who survived over 24 hours after ROSC, factors that predicted survival included the presence of a witness (p<0.001), the implementation of CPR by a bystander (p=0.012), a short time from being found to time of arrival at the hospital (p<0.001) and younger age (p=0.042). Factors that predicted non-survival included no witness at the time of cardiac arrest, a prehospital time longer than 20 minutes, bystander CPR but the initial rhythm was asystole. The positive predict value was 95.6%. CONCLUSION: When an individual has an out-of-hospital cardiac arrest, termination of resuscitation should be considered when there are no witnesses, when there was no bystander to administer CPR, when the initial rhythm was asystole, and when prehospital time was longer than 20 minutes.