When Should Pre-Hospital ACLS be Stopped? By Dr. George Anthony Fidacaro
Fri, 03/24/2017 - 11:33am
Pre-hospital Termination of Resuscitation for Non-traumatic Cardiopulmonary Arrest
- Over 300,000 people in the U.S. suffer an out-of-hospital cardiac arrest (OHCA); although survival from a cardiac etiology is improving, overall survival from OHCA has remained approximately 10%.
- Despite their best efforts, pre-hospital providers will often transport patients to the hospital despite a failure to achieving ROSC. This practice results in unnecessary use of valuable resources and places the community and EMS providers at risk due to high-speed transportation.
- The National Association of EMS Physicians published a position paper in 2011 supporting termination of resuscitation by EMS providers if the:
- arrest was not witnessed by an EMS provider
- patient has no shockable rhythm identified by an AED or other electronic monitor
- patient has no ROSC prior to EMS transport
- In addition to above criteria, studies have also demonstrated poor survival if an ETC02 < 10 at 20 minutes of resuscitation.
- Levine RL, Wayne MA, Miller CC. End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. N Engl J Med. 1997 Jul 31;337(5):301-6
- Millin MG, Khandker SR, Malki A. Termination of resuscitation of nontraumatic cardiopulmonary arrest: resource document for the National Association of EMS Physicians position statement. Prehosp Emerg Care. 2011 Oct-Dec; 15(4):547-54.
- Morrison LJ, Visentin LM, Kiss A, et al. Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2006; 355:478–87