Termination of Resuscitation Rules for In-Hospital Cardiac Arrest

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Prognostics

Background:

• No validated decision rules exist for terminating resuscitation in in-hospital cardiac arrest.
• Existing practices may lead to inappropriate early termination or prolonged, futile resuscitation efforts.

Purpose of the Study:

• To develop and validate clinical decision rules for the termination of resuscitation in adult patients experiencing in-hospital cardiac arrest.
• To identify factors that accurately predict outcomes and guide resuscitation termination decisions.

Main Methods:

• A prognostic study utilizing national cardiac arrest registries from Denmark, Sweden, and Norway.
• Development and validation of termination of resuscitation rules using six bedside-available variables: age, initial rhythm, witnessed status, monitored status, ICU location, and resuscitation duration.
• Rules were selected based on a false-positive rate <1% and a positive rate >10%.

Main Results:

• Five termination of resuscitation rules were identified as clinically relevant from over 53,000 possible combinations.
• The optimal rule incorporated: unwitnessed arrest, unmonitored status, asystole as the initial rhythm, and a resuscitation duration ≥10 minutes.
• This rule had a positive rate of 11% (110/1000) and a false-positive rate of 0.6% (6/1000), indicating accurate prediction of non-survival across all national cohorts.

Conclusions:

• Developed and validated termination of resuscitation rules provide objective guidance for in-hospital cardiac arrest scenarios.
• The best-performing rule demonstrates a low false-positive rate and a reasonable positive rate, supporting its clinical utility.
• These rules have the potential to improve decision-making at the bedside, optimizing patient care and resource allocation.