Advertisement

Application of adult prehospital resuscitation rules to pediatric out of hospital cardiac arrest

  • Satoshi Matsui
    Affiliations
    Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

    Division of Emergency Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
    Search for articles by this author
  • Tetsuhisa Kitamura
    Affiliations
    Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
    Search for articles by this author
  • Hiroshi Kurosawa
    Affiliations
    Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
    Search for articles by this author
  • Kosuke Kiyohara
    Affiliations
    Department of Food Science, Otsuma Women’s University, Tokyo, Japan
    Search for articles by this author
  • Ryojiro Tanaka
    Affiliations
    Division of Emergency Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
    Search for articles by this author
  • Tomotaka Sobue
    Affiliations
    Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
    Search for articles by this author
  • Masahiko Nitta
    Correspondence
    Corresponding author at: Division of Patient Safety, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.
    Affiliations
    Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan

    Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan

    Division of Patient Safety, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
    Search for articles by this author

      Abstract

      Background

      Prehospital termination of resuscitation (TOR) rules can be recommended for adults with out-of-hospital cardiac arrests (OHCAs). This study aimed to investigate whether adult basic life support (BLS) and advanced life support (ALS) TOR rules can predict neurologically unfavorable one-month outcome for pediatric OHCA patients.

      Methods

      From a nationwide population-based observational cohort study, we extracted data of consecutive pediatric OHCA patients (0–17 years old) from January 1, 2005, to December 31, 2011. The BLS TOR rule has three criteria, whereas the ALS TOR rule includes two additional criteria. We selected pediatric OHCA patients that met all criteria for each TOR rule and calculated the specificity and positive predictive value (PPV) of each TOR rule for identifying pediatric OHCA patients who did not have neurologically favorable one-month outcome.

      Results

      Of the 12,740 pediatric OHCA patients eligible for the evaluation of the BLS TOR rule, 10,803 patients met the BLS TOR rule, with a specificity of 0.785 and a PPV of 0.987 for predicting a lack of neurologically favorable one-month survival. Of the 2,091 for the ALS TOR rule, 381 patients met the ALS TOR rule, with a specificity of 0.986 and a PPV of 0.997 for predicting neurologically unfavorable one-month outcome.

      Conclusions

      The adult BLS and ALS TOR rules had a high PPV for predicting pediatric OHCA patients without a neurologically favorable survival at one month after onset.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Perkins G.D.
        • Graesner J.T.
        • Semeraro F.
        • et al.
        European Resuscitation Council Guidelines 2021: Executive summary.
        Resuscitation. 2021; 161: 1-60
        • Merchant R.M.
        • Topjian A.A.
        • Panchal A.R.
        • et al.
        Part 1: Executive Summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2020; 142: S337-S357
        • Nolan J.P.
        • Maconochie I.
        • Soar J.
        • et al.
        Executive summary 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.
        Resuscitation. 2020; 156: A1-A22
        • Sasson C.
        • Hegg A.J.
        • Macy M.
        • et al.
        Prehospital termination of resuscitation in cases of refractory out-of-hospital cardiac arrest.
        JAMA. 2008; 300: 1432-1438
        • Panchal A.R.
        • Bartos J.A.
        • Cabanas J.G.
        • et al.
        Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2020; 142: S366-S468
        • Ebell M.H.
        • Vellinga A.
        • Masterson S.
        • Yun P.
        Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest.
        Emerg Med J. 2019; 36: 479-484
        • Morrison L.J.
        • Verbeek P.R.
        • Zhan C.
        • Kiss A.
        • Allan K.S.
        Validation of a universal prehospital termination of resuscitation clinical prediction rule for advanced and basic life support providers.
        Resuscitation. 2009; 80: 324-328
        • Morrison L.J.
        • Visentin L.M.
        • Kiss A.
        • et al.
        Validation of a Rule for Termination of Resuscitation in Out-of-Hospital Cardiac Arrest.
        N Engl J Med. 2006; 355: 478-487
        • Harris M.I.
        • Crowe R.P.
        • Anders J.
        • D'Acunto S.
        • Adelgais K.M.
        • Fishe J.
        Applying a set of termination of resuscitation criteria to paediatric out-of-hospital cardiac arrest.
        Resuscitation. 2021; 169: 175-181
        • Kajino K.
        • Kitamura T.
        • Iwami T.
        • et al.
        Current termination of resuscitation (TOR) guidelines predict neurologically favorable outcome in Japan.
        Resuscitation. 2013; 84: 54-59
        • Kitamura T.
        • Iwami T.
        • Kawamura T.
        • Nagao K.
        • Tanaka H.
        • Hiraide A.
        Nationwide public-access defibrillation in Japan.
        N Engl J Med. 2010; 362: 994-1004
        • Perkins G.D.
        • Jacobs I.G.
        • Nadkarni V.M.
        • et al.
        Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.
        Circulation. 2015; 132: 1286-1300
        • Kajino K.
        • Iwami T.
        • Daya M.
        • et al.
        Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest.
        Resuscitation. 2010; 81: 549-554
      1. The National Statistics Center. Population census of Japan, 2010 [in Japanese] (Accessed 15 October 2022, at https://www.e-stat.go.jp/stat-search/files?page=1&layout=datalist&toukei=00200521&tstat=000001039448&cycle=0&tclass1=000001065261)

      2. Effect of first aid for cardiopulmonary arrest. FDMA Ambulance Service Planning Office, 2010 [in Japanese] (Accessed 15 October 2022, at https://www.fdma.go.jp/publication/rescue/items/siryo_mokuji.pdf)

      3. Effect of first aid for cardiopulmonary arrest. FDMA Ambulance Service Planning Office, 2019 [in Japanese]. (Accessed 15 October 2022, at https://www.fdma.go.jp/publication/rescue/items/kkkg_r02_01_kyukyu.pdf)

        • Matsui S.
        • Kitamura T.
        • Sado J.
        • et al.
        Location of arrest and survival from out-of-hospital cardiac arrest among children in the public-access defibrillation era in Japan.
        Resuscitation. 2019; 140: 150-158
        • Richman P.B.
        • Vadeboncoeur T.F.
        • Chikani V.
        • Clark L.
        • Bobrow B.J.
        Independent evaluation of an out-of-hospital termination of resuscitation (TOR) clinical decision rule.
        Acad Emerg Med. 2008; 15: 517-521
        • Jacobs I.
        • Nadkarni V.
        • Bahr J.
        • et al.
        Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).
        Circulation. 2004; 110: 3385-3397
      4. Ministry of Health, Labour and Welfare, Ministry of Internal Affairs and Communications, Ministry of Education, Culture, Sports, Science and Technology. Summary of the status of improvement measures (responses) following recommendations based on the results of the administrative evaluation and monitoring of pediatric care [in Japanese]. (Accessed 6 December 2022, at https://www.soumu.go.jp/main_sosiki/hyouka/hyouka_kansi_n/ketsuka_nendo/pdf/081016_1.pdf)

      5. Research Grant Program of the Foundation for the Promotion of Emergency Medical Services. Emergency Medical Technician Hospital Training Survey of the current state of the teaching system and content of teaching [in Japanese]. (Accessed 6 December 2022, at https://fasd.jp/files/libs/308/201511131706227086.pdf)

        • O'Brien E.
        • Hendricks D.
        • Cone D.C.
        Field termination of resuscitation: analysis of a newly implemented protocol.
        Prehosp Emerg Care. 2008; 12: 57-61
        • Marco C.A.
        • Schears R.M.
        Prehospital resuscitation practices: a survey of prehospital providers.
        J Emerg Med. 2003; 24: 101-106
        • Cheung M.
        • Morrison L.
        • Verbeek P.
        Prehospital vs. emergency department pronouncement of death: a cost analysis.
        CJEM. 2001; 3: 19-25
        • Hall 2nd, W.L.
        • Myers J.H.
        • Pepe P.E.
        • Larkin G.L.
        • Sirbaugh P.E.
        • Persse D.E.
        The perspective of paramedics about on-scene termination of resuscitation efforts for pediatric patients.
        Resuscitation. 2004; 60: 175-187