Abstract
Cardiopulmonary resuscitation (CPR) provides possible survival from otherwise fatal
cardiopulmonary collapse. Termination guidelines have been developed for use when
resuscitation has no potential benefit for a victim. The purpose of this prospective
cohort study was to determine if unwitnessed collapse combined with no-bystander cardiopulmonary
resuscitation would support a decision to terminate attempted resuscitation. There
were 541 patients analyzed during 6 months, with functional neurological survival
the outcome of interest. There were no functional neurological survivors at hospital
discharge among the 180 victims in the unwitnessed, no-bystander CPR subgroup (95%
confidence interval [CI] 0.0%–2.1%). Functional neurological survival for witnessed
collapse, bystander CPR was 6.0% (95% CI 2.8%–12.5%), for witnessed collapse, no-bystander
CPR was 3.8% (95% CI 1.9%–7.7%), and for unwitnessed collapse, bystander CPR 1.3%
(95% CI 0.2%–6.9%). With confirmation by further studies, unwitnessed collapse and
lack of bystander CPR may be a practical addition to resuscitation termination guidelines.
Keywords
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References
- Major changes in the 2005 AHA Guidelines for CPR and ECC.Circulation. 2005; 112: IV206-IV211
- A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest.Ann Emerg Med. 1999; 34: 517-525
- Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective analysis.Prehosp Emerg Care. 2001; 3: 261-269
- Ambulance crash-related injuries among Emergency Medical Services workers—United States, 1991–2002.MMWR Morb Mortal Wkly Rep. 2003; 8: 154-156
- Relative risk of injury and death in ambulances and other emergency vehicles.Accid Anal Prev. 2003; 6: 941-948
- Termination of resuscitation in the prehospital setting for adult patients suffering nontraumatic cardiac arrest.Prehosp Emerg Care. 2000; 4: 190-195
- Unwitnessed out-of-hospital cardiac arrest: is resuscitation worthwhile?.Ann Emerg Med. 1997; 30: 69-75
- Cardiac arrest resuscitation evaluation in Los Angeles: CARE-LA.Ann Emerg Med. 2005; 45: 504-509
- Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS study phase I results.Ann Emerg Med. 1999; 33: 44-50
- Comparison of two emergency response systems and their effect on survival from out of hospital cardiac arrest.Resuscitation. 1997; 32: 225-229
- Out-of-hospital cardiac arrests: an 8-year New York City experience.Am J Emerg Med. 1996; 14: 364-369
- Prediction rules for estimating neurologic outcome following out-of-hospital cardiac arrest.Resuscitation. 2004; 63: 145-155
- United States Census 2000 (US Department of Commerce Web site).http://www.census.govDate: 2002
- A randomized clinical study of cardiopulmonary-cerebral resuscitation: design, methods, and patient characteristics.Am J Emerg Med. 1986; 4: 72-86
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation.Circulation. 2004; 110: 3385-3397
- Statistics with confidence.in: Altman D.G. Machin D. Bryant T.N. Gardner M.J. Calculating confidence intervals for proportions and their differences. 2nd edn. British Medical Journal, London, UK2000: 45-56
- Outcome of out-of-hospital cardiac arrest in New York City.JAMA. 1994; 271: 678-683
- Outcome of CPR in a large metropolitan area—where are the survivors?.Ann Emerg Med. 1991; 20: 355-361
- Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation.Am J Emerg Med. 1985; 3: 114-119
- The effect of bystander CPR on neurologic outcome in survivors of prehospital cardiac arrests.Resuscitation. 1989; 17: 91-98
- Bystander vs EMS first-responder CPR: initial rhythm and outcome in witnessed nonmonitored out-of-hospital cardiac arrest.Acad Emerg Med. 1995; 2: 494-498
- Can we define patients with no chance of survival after out-of-hospital cardiac arrest?.Heart. 2004; 10: 1114-1118
- Bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest.Resuscitation. 1989; 17: S55-S69
- Prehospital cardiac arrest: the impact of witnessed collapse and bystander CPR in a metropolitan EMS system with short response times.Ann Emerg Med. 1990; 19: 1264-1269
- Measuring survival rates from sudden cardiac arrest: the elusive definition.Resuscitation. 2004; 62: 25-34
Article info
Publication history
Published online: August 30, 2007
Accepted:
November 16,
2006
Received in revised form:
July 18,
2006
Received:
August 31,
2005
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
