Acute cardiac care & resuscitation
Termination of Resuscitation Rules for In-Hospital Cardiac Arrest
Authors' conclusion
In this prognostic study, 5 termination of resuscitation rules were developed and validated for in-hospital cardiac arrest. The best performing rule had a low false-positive rate and a reasonable positive rate in all national cohorts. These termination of resuscitation rules may aid decision-making during resuscitation.
Study context
- Population
- Patients with in-hospital cardiac arrest in national registries from Denmark (2017 to 2022), Sweden (2007 to 2021) and Norway (2021 to 2022)cohorts by country
- Participants
- 9,863 / 12,781 / 1,308
- Comparison
- Termination of resuscitation rules built from six bedside variables (age, initial rhythm, witnessed status, monitored status, intensive care unit location, and resuscitation duration) for predicting 30-day mortality
- Danishn = 9,863
- Swedishn = 12,781
- Norwegiann = 1,308
- Outcome
- 30-day mortality (best performing rule: unwitnessed, unmonitored, initial rhythm of asystole, and resuscitation duration more than or equal to 10 minutes)
- Follow-up
- 30 days
Methodological detailsdevelopment using a national in-hospital cardiac arrest registry from Denmark, validation using registries from Sweden and Norway, CIs obtained using bootstrapping
- Development using a national in-hospital cardiac arrest registry from Denmark
- Validation using registries from Sweden and Norway
- CIs obtained using bootstrapping
Performance
As reported in the abstract
Termination proposed per 1000 cardiac arrests
110
Positive rate
11%; 95% CI, 10%-11%
30-day mortality predicted incorrectly per 1000 cases
6
False-positive rate
0.6%; 95% CI, 0.3%-0.9%
Further findings
Cohort characteristics
- Overall median (IQR) age
- 74 (66-81) years
- Male
- 63%
- Median (IQR) resuscitation duration
- 13 (5-23) minutes
Rules identified
- Possible termination rules
- 53 864
- Rules identified as relevant for clinical use
- 5
- All 5 rules performed similarly across all 3 cohorts
Original publication
Termination of Resuscitation Rules for In-Hospital Cardiac Arrest. JAMA Intern Med. Published 1 April 2025. doi:10.
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