J Korean Med Sci.  2015 Jan;30(1):104-109. 10.3346/jkms.2015.30.1.104.

The Scene Time Interval and Basic Life Support Termination of Resuscitation Rule in Adult Out-of-Hospital Cardiac Arrest

• Kim TH
• Shin SD
• Kim YJ
• Kim CH
• Kim JE

• KMID: 2155454
• DOI: http://doi.org/10.3346/jkms.2015.30.1.104

Abstract

We validated the basic life support termination of resuscitation (BLS TOR) rule retrospectively using Out-of-Hospital Cardiac Arrest (OHCA) data of metropolitan emergency medical service (EMS) in Korea. We also tested it by investigating the scene time interval for supplementing the BLS TOR rule. OHCA database of Seoul (January 2011 to December 2012) was used, which is composed of ambulance data and hospital medical record review. EMS-treated OHCA and 19 yr or older victims were enrolled, after excluding cases occurred in the ambulance and with incomplete information. The primary and secondary outcomes were hospital mortality and poor neurologic outcome. After calculating the sensitivity (SS), specificity (SP), and the positive and negative predictive values (PPV and NPV), tested the rule according to the scene time interval group for sensitivity analysis. Of total 4,835 analyzed patients, 3,361 (69.5%) cases met all 3 criteria of the BLS TOR rule. Of these, 3,224 (95.9%) were dead at discharge (SS,73.5%; SP,69.6%; PPV,95.9%; NPV, 21.3%) and 3,342 (99.4%) showed poor neurologic outcome at discharge (SS, 75.2%; SP, 89.9%; PPV, 99.4%; NPV, 11.5%). The cut-off scene time intervals for 100% SS and PPV were more than 20 min for survival to discharge and more than 14 min for good neurological recovery. The BLS TOR rule showed relatively lower SS and PPV in OHCA data in Seoul, Korea.

Keyword

Out-of-Hospital Cardiac Arrest; Cardiopulmonary Resuscitation; Decision Support Technique

MeSH Terms

Adult
Advanced Cardiac Life Support/*mortality
Cardiopulmonary Resuscitation/*mortality
Critical Care/statistics & numerical data
Decision Support Techniques
Electric Countershock/*mortality
Emergency Medical Services
Female
Hospital Mortality
Humans
Male
Out-of-Hospital Cardiac Arrest/*epidemiology/*mortality/therapy
Refusal to Treat
Republic of Korea/epidemiology
Retrospective Studies
Survival Rate
Time Factors
Time-to-Treatment
Treatment Outcome

Figure

• 

  Fig. 1 Patient enrollment flow. EMS, emergency medical service; OHCA, out-of-hospital cardiac arrest; ROSC, return of spontaneous circulation.

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