Acute cardiac care & resuscitation
External validation of rules for termination of resuscitation in in-hospital cardiac arrest
Authors' conclusion
In this large American cohort, previously derived termination rules for in-hospital cardiac arrest demonstrated either limited applicability or unacceptable error rates. Even the best-performing Scandinavian rule identified few patients for early termination and would have led to premature cessation in ∼5% of survivors. These findings underscore the need for further refinement of termination rules before clinical adoption in the United States.
Study context
- Population
- Adult patients (≥18 years) who suffered in-hospital cardiac arrestmet inclusion criteria, of 646,794 patients, across 703 hospitals
- Participants
- 359,686 patients
- Exposure
- Meeting a previously described termination of resuscitation rule
- Outcome
- Survival to hospital discharge
- Follow-up
- Hospital discharge
Methodological detailsexternal validation, years 2012-2024, American Heart Association Get With The Guidelines-Resuscitation registry, Hypothesis formulated prior to analysis
- External validation
- Years 2012-2024
- American Heart Association Get With The Guidelines-Resuscitation registry
- Hypothesis formulated prior to analysis
Main finding
As reported in the abstract
Overall survival to discharge
23.1%
Survived to discharge, of patients meeting Rule 1 criteria
5.1%
Observational data: associations, not effects.
Further findings
Positive rate (patients meeting Rule criteria), Rule 1
- Positive rate, Rule 1
- 1.7%
- Achieved return of spontaneous circulation, of patients meeting Rule 1 criteria
- 32.9%
Resuscitation time potentially avoided, Rule 1
- Median per patient meeting Rule 1 criteria
- 11 min
- Per 100 events
- ∼18 min
Positive rates across hospitals
- Range
- 0% to 11.9
Other termination rules
- Other termination rules demonstrated either very low average positive rates (<3%) or unacceptably high survival rates among patients meeting the rule
Sensitivity analyses excluding the COVID-19 era
- Findings were similar
Original publication
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