Abstract 17719: A New Termination-of-resuscitation Rule for Out-of-hospital Cardiac Arrest in the Japanese Population

Abstract

Background: Termination of resuscitation (TOR) rules for out-of-hospital cardiac arrest (OHCA) have been constructed for better utilization of hospital healthcare resources and increasing the availability of care for other patients. However, TOR rules in the prehospital settings are not legally implemented in Japan. Thus, almost all OHCA patients are transported to the hospital, regardless to the possibility of successful resuscitation. Objective: To validate the TOR-ALS rule in the Japanese population and to establish a new TOR rule for terminating ongoing resuscitation just after hospital arrival. Methods: The Fire and Disaster Management Agency (FDMA) of Japan developed a nationwide database of a prospective population-based cohort using an Utstein-style template for OHCA patients since January 2005. Data from January 2005 to December 2012 of this database was used for the current analysis. We constructed a new TOR rule consisting of 5 factors (no-witness, no-ROSC, asystole for the initial rhythm, no-defibrillation, age). Positive predictive value(PPV), negative predictive value(NPV), sensitivity, specificity and receiver operating characteristic(ROC) curve to predict Cerebral Performance Category(CPC) 3 to 5 at one-month for the TOR-ALS rule (no-witness, no-bystander, no-return of spontaneous circulation (ROSC), no-defibrillation before hospital arrival) and the new rule. Results: In the database, 925,288 patients were documented for the study period. Adult patients 18 years or older with OHCA without external causes of arrest were included, resulting in 708,933(77%) patients in the present analysis. Values were as followed for the TOR-ALS rule, PPV99.88%, NPV3.27%, sensitivity31.41%, specificity98.39%, Area Under Curve(AUC)-ROC0.649, and for the new rule, PPV99.96%, NPV3.40%, sensitivity33.45%, specificity99.40%, AUC-ROC0.664. Conclusion: The new TOR rule has a higher PPV and specificity to predict unfavorable outcome of OHCA in a Japanese population. Validation is required to prove the clinical utility of the rule.