OHCA: a 3-item rule accurately predicts futility

  • Glober NK & al.
  • Resuscitation
  • 19 jun. 2019

  • de Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • After out-of-hospital cardiac arrest (OHCA), a simple decision rule could reduce futile attempts at resuscitation.
  • The rule resembles another that was recently validated.
  • Authors suggest pursuing resuscitation if patient age is unknown. 
  • Validation studies needed.

Why this matters

  • Resuscitation and transportation are costly and put providers and bystanders at risk.
  • When patients survive to hospital admission but die shortly thereafter, families suffer emotionally and financially.
  • No widely accepted guideline helps providers decide which arrest resuscitations are futile.

Key results

  • A 3-item rule was 100% specific for arrests that did not survive to discharge (n=223):
    • Patients age ≥80 years.
    • Unwitnessed arrest. 
    • Nonshockable initial rhythm.
  • Authors suggest acronym “NUE”: Nonshockable initial rhythm, Unwitnessed, Eighty or older.
  • Another rule was 100% specific for arrests that did not survive with good neurological outcome (n=296):
    • Patients age ≥80 years.
    • Arrest at home.
    • Nonshockable initial rhythm.

Study design

  • Retrospective cohort study of 4 years of paramedic-attended cardiac arrests in a California county, recorded in Cardiac Arrest Registry to Enhance Survival database (n=1706).
  • Based on characteristics of patients, arrests, and emergency response, authors developed rule to predict resuscitation futility.
  • Funding: None disclosed.

Limitations

  • Single-system study without validation cohort.