Field termination-of-resuscitation rule for refractory out-of-hospital cardiac arrests in Japan.

摘要: Abstract Background Guidelines for cardiopulmonary resuscitation (CPR) recommend using the universal termination-of-resuscitation (TOR) rule to identify out-of-hospital cardiac arrest (OHCA) patients eligible field termination of resuscitation, thus avoiding medically futile transportation hospital. However, in Japan, emergency medical services (EMS) personnel are forbidden from terminating CPR and transport almost all with OHCA hospitals. We aimed develop validate a novel TOR CPR. Methods analyzed 540,478 2011 2015 Japanese registry. Main outcome measures were specificity positive predictive value (PPV) newly developed predicting 1-month mortality after OHCA. Results Recursive partitioning analysis development group (n = 434,208) showed that EMS could consider if met following five criteria: (1) initial asystole, (2) unwitnessed by bystander, (3) age ≥81 years, (4) no bystander-administered or automated external defibrillator use before arrival, (5) return spontaneous circulation EMS-initiated 14 min. For meeting these criteria, PPV 99.2% [95% confidence interval (CI), 99.0–99.3%] 99.7% (95% CI, 99.6–99.7%), respectively, 99.5% 99.3–99.7%) 99.8% 99.7–99.9%), validation group. Implementation this would reduce patient transports hospitals 10.6% 10.4% Conclusions Having both high >99% mortality, our may be applied who meet criteria. Prospective studies establishment prehospital protocol required implementing rule.