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When Can EMS Stop Resuscitation?

Posted Sep 28 2008 11:50am
Comilla Sasson and colleagues have an article in the current issue of JAMA titled Prehospital Termination of Resuscitation in Cases of Refractory Out-of-Hospital Cardiac Arrest.

They identify criteria for stopping resusciation efforts by EMS personnel:
  1. Cardiac arrest not witnessed
  2. No external defribilator applied out of hospital
  3. No spontaneous circulation out of hospital
  4. CPR not administered by bystander

Few patients (0.1% of 5500 studied) who are resuscitated and brought to the hospital by EMS survive to hospital discharge. Zero who met the criteria for stopping survived. Assuming this is an appropriate measure of inappropriate treatment, the stopping rules have a high validity.

The authors offer some benefits for following the stopping rules:
  1. Reduce risk EMS during transport
  2. Decrease pressure on EMS systems
  3. Allow EMS to focus on patients with greater survival odds
  4. Decrease admissions to ICUs of patients with no chance of survivial

Arthur Sanders has an editorial on the study suggesting that stopping rules may be unnecessary and may thwart developments in emergency treatment.
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