Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols
Abstract Background Resuscitation guidance has advanced; however, the predictive performance of the termination of resuscitation (TOR) rule has not been validated for different resuscitation protocols published by the American Heart Association (AHA). Methods A retrospective study validating the bas...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-03-01
|
| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12873-022-00606-8 |
| _version_ | 1819052110051803136 |
|---|---|
| author | Yu-Yuan Lin Yin-Yu Lai Hung-Chieh Chang Chien-Hsin Lu Po-Wei Chiu Yuh-Shin Kuo Shao-Peng Huang Ying-Hsin Chang Chih-Hao Lin |
| author_facet | Yu-Yuan Lin Yin-Yu Lai Hung-Chieh Chang Chien-Hsin Lu Po-Wei Chiu Yuh-Shin Kuo Shao-Peng Huang Ying-Hsin Chang Chih-Hao Lin |
| author_sort | Yu-Yuan Lin |
| collection | DOAJ |
| description | Abstract Background Resuscitation guidance has advanced; however, the predictive performance of the termination of resuscitation (TOR) rule has not been validated for different resuscitation protocols published by the American Heart Association (AHA). Methods A retrospective study validating the basic life support (BLS) and advanced life support (ALS) TOR rules was conducted using an Utstein-style database in Tainan city, Taiwan. Adult patients with nontraumatic out-of-hospital cardiac arrests from January 1, 2015, to December 31, 2015, (using the AHA 2010 resuscitation protocol) and from January 1, 2020, to December 31, 2020, (using the AHA 2015 resuscitation protocol) were included. The characteristics of rule performance were calculated, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value. Results Among 1260 eligible OHCA patients in 2015, 757 met the BLS TOR rule and 124 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 61.1% and 99.0%, respectively, for the BLS TOR rule and 93.8% and 99.2%, respectively, for the ALS TOR rule. A total of 970 OHCA patients were enrolled in 2020, of whom 438 met the BLS TOR rule and 104 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 85.7% and 100%, respectively, for the BLS TOR rule and 99.5% and 100%, respectively, for the ALS TOR rule. Conclusions Both the BLS and ALS TOR rules performed better when using the 2015 AHA resuscitation protocols compared to the 2010 protocols, with increased PPVs and decreased false-positive rates in predicting survival to discharge and good neurological outcomes at discharge. The BLS and ALS TOR rules can perform differently while the resuscitation protocols are updated. As the concepts and practices of resuscitation progress, the BLS and ALS TOR rules should be evaluated and validated accordingly. |
| first_indexed | 2024-12-21T12:14:37Z |
| format | Article |
| id | doaj.art-c762282bccf54968934bb4fbeb10ab47 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-21T12:14:37Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-c762282bccf54968934bb4fbeb10ab472022-12-21T19:04:29ZengBMCBMC Emergency Medicine1471-227X2022-03-012211910.1186/s12873-022-00606-8Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocolsYu-Yuan Lin0Yin-Yu Lai1Hung-Chieh Chang2Chien-Hsin Lu3Po-Wei Chiu4Yuh-Shin Kuo5Shao-Peng Huang6Ying-Hsin Chang7Chih-Hao Lin8Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityAbstract Background Resuscitation guidance has advanced; however, the predictive performance of the termination of resuscitation (TOR) rule has not been validated for different resuscitation protocols published by the American Heart Association (AHA). Methods A retrospective study validating the basic life support (BLS) and advanced life support (ALS) TOR rules was conducted using an Utstein-style database in Tainan city, Taiwan. Adult patients with nontraumatic out-of-hospital cardiac arrests from January 1, 2015, to December 31, 2015, (using the AHA 2010 resuscitation protocol) and from January 1, 2020, to December 31, 2020, (using the AHA 2015 resuscitation protocol) were included. The characteristics of rule performance were calculated, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value. Results Among 1260 eligible OHCA patients in 2015, 757 met the BLS TOR rule and 124 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 61.1% and 99.0%, respectively, for the BLS TOR rule and 93.8% and 99.2%, respectively, for the ALS TOR rule. A total of 970 OHCA patients were enrolled in 2020, of whom 438 met the BLS TOR rule and 104 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 85.7% and 100%, respectively, for the BLS TOR rule and 99.5% and 100%, respectively, for the ALS TOR rule. Conclusions Both the BLS and ALS TOR rules performed better when using the 2015 AHA resuscitation protocols compared to the 2010 protocols, with increased PPVs and decreased false-positive rates in predicting survival to discharge and good neurological outcomes at discharge. The BLS and ALS TOR rules can perform differently while the resuscitation protocols are updated. As the concepts and practices of resuscitation progress, the BLS and ALS TOR rules should be evaluated and validated accordingly.https://doi.org/10.1186/s12873-022-00606-8Out-of-hospital cardiac arrestPredictive performanceTermination of resuscitationResuscitationBasic life supportAdvanced life support |
| spellingShingle | Yu-Yuan Lin Yin-Yu Lai Hung-Chieh Chang Chien-Hsin Lu Po-Wei Chiu Yuh-Shin Kuo Shao-Peng Huang Ying-Hsin Chang Chih-Hao Lin Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols BMC Emergency Medicine Out-of-hospital cardiac arrest Predictive performance Termination of resuscitation Resuscitation Basic life support Advanced life support |
| title | Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols |
| title_full | Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols |
| title_fullStr | Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols |
| title_full_unstemmed | Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols |
| title_short | Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols |
| title_sort | predictive performances of als and bls termination of resuscitation rules in out of hospital cardiac arrest for different resuscitation protocols |
| topic | Out-of-hospital cardiac arrest Predictive performance Termination of resuscitation Resuscitation Basic life support Advanced life support |
| url | https://doi.org/10.1186/s12873-022-00606-8 |
| work_keys_str_mv | AT yuyuanlin predictiveperformancesofalsandblsterminationofresuscitationrulesinoutofhospitalcardiacarrestfordifferentresuscitationprotocols AT yinyulai predictiveperformancesofalsandblsterminationofresuscitationrulesinoutofhospitalcardiacarrestfordifferentresuscitationprotocols AT hungchiehchang predictiveperformancesofalsandblsterminationofresuscitationrulesinoutofhospitalcardiacarrestfordifferentresuscitationprotocols AT chienhsinlu predictiveperformancesofalsandblsterminationofresuscitationrulesinoutofhospitalcardiacarrestfordifferentresuscitationprotocols AT poweichiu predictiveperformancesofalsandblsterminationofresuscitationrulesinoutofhospitalcardiacarrestfordifferentresuscitationprotocols AT yuhshinkuo predictiveperformancesofalsandblsterminationofresuscitationrulesinoutofhospitalcardiacarrestfordifferentresuscitationprotocols AT shaopenghuang predictiveperformancesofalsandblsterminationofresuscitationrulesinoutofhospitalcardiacarrestfordifferentresuscitationprotocols AT yinghsinchang predictiveperformancesofalsandblsterminationofresuscitationrulesinoutofhospitalcardiacarrestfordifferentresuscitationprotocols AT chihhaolin predictiveperformancesofalsandblsterminationofresuscitationrulesinoutofhospitalcardiacarrestfordifferentresuscitationprotocols |