Abstract
Objective
Prehospital Termination of Resuscitation (TOR) protocols for adults can reduce the
number of futile transports of patients in cardiac arrest, yet similar protocols are
not widely available for paediatric out-of-hospital cardiac arrest (POHCA). The objective
of this study was to apply a set of criteria for paediatric TOR (pTOR) from the Maryland
Institute for Emergency Medical Services Systems (MIEMSS) to a large national cohort
and determine its association with return of spontaneous circulation (ROSC) after
POHCA.
Methods
We identified patients ages 0–17 treated by Emergency Medical Services (EMS) with
cardiac arrest in 2019 from the ESO dataset and and applied the applicable pTOR certeria
for medical or traumatic arrests. We calculated predictive test characteristics for
the outcome of prehospital ROSC, stratified by medical and traumatic cause of arrest.
Results
We analyzed records for 1595 POHCA patients. Eighty-eight percent (n = 1395) were classified as medical. ROSC rates were 23% among medical POHCA and 27%
among traumatic POHCA. The medical criteria correctly classified >99% (322/323) of
patients who achieved ROSC as ineligible for TOR. The trauma criteria correctly classified
93% (50/54) of patients with ROSC as ineligible for TOR. Of the five misclassified
patients, three were involved in drowning incidents.
Conclusions
The Maryland pTOR criteria identified eligible patients who did not achieve prehospital
ROSC, while reliably excluding those who did achieve prehospital ROSC. As most misclassified
patients were victims of drowning, we recommend considering the exclusion of drowning
patients from future pTOR guidelines. Further studies are needed to evaluate the long-term
survival and neurologic outcome of patients misclassified by pTOR criteria.
Keywords
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Article info
Publication history
Published online: September 20, 2021
Accepted:
September 13,
2021
Received in revised form:
September 8,
2021
Received:
June 4,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
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