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Predictive performance of universal termination of resuscitation rules in an Asian community: are they accurate enough?
  1. Wen-Chu Chiang1,2,
  2. Patrick Chow-In Ko1,2,
  3. Anna Marie Chang3,
  4. Sot Shih-Hung Liu1,
  5. Hui-Chih Wang1,
  6. Chih-Wei Yang1,2,
  7. Ming-Ju Hsieh1,2,
  8. Shey-Ying Chen1,2,
  9. Mei-Shu Lai2,
  10. Matthew Huei-Ming Ma1
  1. 1Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
  2. 2Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
  3. 3Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA
  1. Correspondence to Professor Matthew Huei-Ming Ma, Department of Emergency Medicine, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Zhongzheng District, Taipei 100, Taiwan;{at}


Introduction Prehospital termination of resuscitation (TOR) rules have not been widely validated outside of Western countries. This study evaluated the performance of TOR rules in an Asian metropolitan with a mixed-tier emergency medical service (EMS).

Methods We analysed the Utstein registry of adult, non-traumatic out-of-hospital cardiac arrests (OHCAs) in Taipei to test the performance of TOR rules for advanced life support (ALS) or basic life support (BLS) providers. ALS and BLS-TOR rules were tested in OHCAs among three subgroups: (1) resuscitated by ALS, (2) by BLS and (3) by mixed ALS and BLS. Outcome definition was in-hospital death. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and decreased transport rate (DTR) among various provider combinations were calculated.

Results Of the 3489 OHCAs included, 240 were resuscitated by ALS, 1727 by BLS and 1522 by ALS and BLS. Overall survival to hospital discharge was 197 patients (5.6%). Specificity and PPV of ALS-TOR and BLS-TOR for identifying death ranged from 70.7% to 81.8% and 95.1% to 98.1%, respectively. Applying the TOR rules would have a DTR of 34.2–63.9%. BLS rules had better predictive accuracy and DTR than ALS rules among all subgroups.

Conclusions Application of the ALS and BLS TOR rules would have decreased OHCA transported to the hospital, and BLS rules are reasonable as the universal criteria in a mixed-tier EMS. However, 1.9–4.9% of those who survived would be misclassified as non-survivors, raising concern of compromising patient safety for the implementation of the rules.

  • emergency ambulance systems
  • cardiac arrest
  • prehospital care
  • resuscitation

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