Acute cardiac care & resuscitation
Evaluation of interventions in prehospital and in-hospital settings and outcomes for out-of-hospital cardiac arrest patients meeting the termination of resuscitation rule in Japan: A nationwide database study (The Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest (JAAM-OHCA) Registry)
Authors' conclusion
OHCA patients who met TOR rule showed a decrease in in-hospital interventions. Further efforts are warranted to avoid futile medical treatments and promote patient-centered care.
Study context
- Population
- Adult out-of-hospital cardiac arrest (OHCA) patients with medical causes who fulfilled all the advanced life support (ALS) termination of resuscitation (TOR) rule criteria: unwitnessed arrest, no return of spontaneous circulation, no bystander-initiated cardiopulmonary resuscitation, and no automated external defibrillator use or defibrillation; JAAM-OHCA registry, June 2014-December 2021patients meeting the inclusion criteria, 2,447 received all three ALS interventions
- Participants
- 11,334 patients
- Exposure
- Temporal trends in prehospital and in-hospital interventions for OHCA patients meeting the TOR rule
- Outcome
- Receipt of all three ALS interventions (advanced airway management, intravenous access, and epinephrine administration)
Methodological detailsnationwide database study
- Nationwide database study
Main finding
As reported in the abstract
Patients who received all three ALS interventions
2,447
Observational data: associations, not effects.
Further findings
In-hospital interventions over time
- Endotracheal intubation (decreased over time)
- 56%
- Epinephrine administration (decreased over time)
- 82%
- Coronary angiography, extracorporeal membrane oxygenation, and targeted temperature management remained rare
- <1%
Median time to TOR after hospital arrival
- Median time to TOR after hospital arrival shortened to
- 18 min
Prehospital interventions over time
- Prehospital epinephrine administration increased
- Advanced airway management and intravenous access decreased
Original publication
Evaluation of interventions in prehospital and in-hospital settings and outcomes for out-of-hospital cardiac arrest patients meeting the termination of resuscitation rule in Japan: A nationwide database study (The JAAM-OHCA Registry). Resuscitation. Published 5 February 2025. doi:10.
Summarised from the published abstract; every number is checked against it