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. 2022 Jan:170:160-166.
doi: 10.1016/j.resuscitation.2021.11.034. Epub 2021 Dec 3.

Impact of dispatcher-assisted cardiopulmonary resuscitation on performance of termination of resuscitation criteria

Alexander T Limkakeng  1 , Jinny J Ye  1 , Catherine Staton  1 , Yih Yng Ng  2 , Benjamin S H Leong  3 , Nur Shahidah  4 , Muhammad Yazid  5 , Alexander Gordee  6 , Maragatha Kuchibhatla  6 , Marcus E H Ong  7 ; Singapore PAROS Investigators
Affiliations

Impact of dispatcher-assisted cardiopulmonary resuscitation on performance of termination of resuscitation criteria

Alexander T Limkakeng et al. Resuscitation. 2022 Jan.

Abstract

Background: Current Advanced Life Support Termination of Resuscitation (TOR) guidelines suggest when to cease cardiopulmonary resuscitation (CPR). With the significant increase of Dispatch-Assisted CPR (DA-CPR) programs, the impact of DA-CPR on the TOR criteria performance is not clear.

Methods: We conducted a secondary analysis of a prospectively collected registry, the Pan-Asian Resuscitation Outcomes Study. We included patients >15 years old with out-of-hospital cardiac arrest between 2014 and 2017 (after implementation of Singapore's DA-CPR program). We excluded patients with non-cardiac etiology, known do-not-resuscitate status, and healthcare provider bystanders. All cases were collected in accordance to Utstein standards. We evaluated the addition of DA-CPR to the diagnostic performance of TOR criteria using logistic regression modeling. The primary outcome was performance for predicting non-survival at 30 days. Sensitivity, specificity, and positive and negative predictive values were calculated.

Results: Of the 6009 cases, 319 (5.3%) were still alive at 30 days. Patients had a mean age of 67.9 (standard deviation 15.7) years and were mostly male and Chinese. Almost half of patients had no bystander CPR. The TOR criteria differentiating DA-CPR from unassisted bystander CPR has a specificity of 94% and predictive value of death of 99%, which was not significantly different from undifferentiated CPR criteria. There were differences in adjusted association with survival between unassisted and DA-CPR.

Conclusion: Advanced life support TOR criteria retain high specificity and predictive value of death in the context of DA-CPR. Further research should explore the differences between unassisted CPR and DA-CPR to understand differential survival outcomes.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Circulation return; Emergency medical services; Resuscitation; Spontaneous.

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Figures

Figure 1:
Figure 1:
OHCA events recorded in the PAROS database between January 2014 and December 2017 OHCA= Out of Hospital Cardiac Arrest; PAROS= Pan-Asian Resuscitation Outcomes Study; DNR= Do Not Resuscitate; ED= Emergency Department; EMS= Emergency Medical Systems
See this image and copyright information in PMC

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