Out-of-Hospital Cardiac Arrest Termination of Resuscitation Rules

Red Cross Guidelines

It is reasonable for prehospital systems to include locally validated termination of resuscitation rules in their medical protocols for adult out-of-hospital cardiac arrest. UPDATED
For pediatric patients in out-of-hospital cardiac arrest, there is insufficient evidence to suggest the use of termination of resuscitation rules to decide whether to terminate resuscitation efforts. NEW

Insights

A recent systematic review examined the use of termination of resuscitation rules in the out-of-hospital setting for both adult and pediatric cardiac arrest. For children, evidence was very limited and does not currently support the use of a termination of resuscitation rule. Adult termination of resuscitation rules performed poorly when applied to children, and a newly derived pediatric termination of resuscitation rule showed high specificity but very low sensitivity.

For adults, numerous termination of resuscitation rules (e.g., Universal Termination of Resuscitation, Universal Advanced Life Support/Basic Life Support Termination of Resuscitation) demonstrated high specificity for predicting in-hospital death or unfavorable neurological outcome, though sensitivity varied widely. Cost-effectiveness analyses suggested termination of resuscitation implementation may reduce unnecessary transport and costs, particularly in emergency medical services (EMS) systems where all patients are otherwise transported. However, all evidence was observational, with risk of bias and lack of prospective validation. Termination of resuscitation rules risk occasional missed survivors. Local validation is essential, as rule performance varies by EMS systems, patient population and survival rates.