When to Terminate Resuscitation for Rural EMS

September 4, 2017

Spoon Feed
The universal basic life support termination of resuscitation (BLS-TOR) rule was effective in reducing futile transports in a rural EMS system.

Why does this matter?
Clear rules for stopping CPR are important for prehospital care providers, especially in rural EMS systems.  Transporting patients lights & sirens with no prognosis for meaningful recovery carries risk for EMS providers, consumes valuable time and resources in areas that are already underserved by EMS, and does not benefit the patient or family.

BLS-TOR
The AHA has published termination of resuscitation rules.  In short, if all of the criteria are met, efforts should be terminated.

• Arrest not witnessed by emergency medical services personnel
• No return of spontaneous circulation (prior to transport)
• No AED shock was delivered (prior to transport)

This was a retrospective, before and after study in rural Vermont.  329 patients had out of hospital cardiac arrest (OHCA) during the study period and were included.  In the 2 years prior to implementation of BLS-TOR, 91.1% of patients were transported.  Afterward, 69.4% were transported.  None of the patients that met BLS-TOR criteria survived to discharge.  One question Thomas raised was how long to attempt resuscitation to see if patients have ROSC prior to transport? It is not clear from this study.

Source
Implementation of the universal BLS termination of resuscitation rule in a rural EMS system.  Resuscitation. 2017 Jul 13;118:75-81. doi: 10.1016/j.resuscitation.2017.07.004. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.