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Related Concept Videos

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Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
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Updated: May 26, 2026

Standardized Model of Ventricular Fibrillation and Advanced Cardiac Life Support in Swine
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Reevaluating basic life support termination criteria using post-arrival data in Japanese out-of-hospital cardiac

Akira Suekane1, Wataru Takayama1,2, Koji Morishita1,2

  • 1Department of Acute Critical Care and Disaster Medicine, Graduate School of Institute of Science Tokyo, Institute of Science Tokyo, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.

Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine
|May 25, 2026
PubMed
Summary

Adding serum potassium levels to basic life support termination of resuscitation rules significantly improves prediction accuracy for out-of-hospital cardiac arrest survival. This finding offers a novel approach to guide resuscitation decisions in emergency medicine.

Keywords:
Basic life support termination of resuscitation ruleOut-of-hospital cardiac arrestSerum potassium level

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Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs

Published on: July 12, 2022

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Clinical Research

Background:

  • Termination of resuscitation (TOR) rules are standard for out-of-hospital cardiac arrest (OHCA), but their application is limited in some Asian countries.
  • Assessing the impact of post-arrival variables can refine existing TOR protocols for better patient outcomes.

Purpose of the Study:

  • To evaluate the accuracy of the basic life support (BLS)-TOR rule by incorporating post-arrival variables in eligible OHCA patients.
  • To identify key in-hospital markers that can enhance the predictive value of TOR criteria.

Main Methods:

  • A multicenter retrospective cohort study analyzing data from a nationwide Japanese OHCA registry (2014-2021).
  • Inclusion of 59,114 patients, with 43,737 meeting BLS-TOR criteria, to assess 30-day survival and neurological outcomes.
  • Multivariate analysis to identify predictors of outcome, focusing on serum potassium levels.

Main Results:

  • The 30-day survival and favorable neurological outcome rates were low (0.9% and 0.1%, respectively).
  • Serum potassium was identified as the strongest predictor of poor outcomes (aOR for survival: 0.45).
  • Adding serum potassium thresholds (≥5.0, ≥6.0, ≥7.0 mEq/L) to BLS-TOR criteria progressively decreased survival rates, with high specificity (0.99) and positive predictive value (1.00) at ≥7.0 mEq/L for mortality.

Conclusions:

  • Incorporating post-arrival, in-hospital variables like serum potassium offers a novel and accurate method to guide TOR decisions.
  • Serum potassium is a readily measurable marker at arrival that significantly enhances the predictive capability of TOR rules.
  • This approach can refine clinical practice for managing OHCA patients where traditional TOR rules are restricted.