Modified clinical decision rule for termination-of-resuscitation in cases of refractory out-of-hospital cardiac arrest

Y Goto,T Maeda,H Inaba

doi:10.1186/cc10882

Abstract

Two international termination-of-resuscitation (TOR) rules for the emergency medical services (EMS) personnel have been proposed to identify nonsurvivors after out-of-hospital cardiac arrest (OHCA). The first is for use by responders providing basic life support (BLS) which includes three criteria: not witnessed by EMS personnel, no shocks are administered and no return of spontaneous circulation (ROSC). The other is for use by responders providing advanced life support (ALS) which adds two criteria: unwitnessed by a bystander and no bystander cardiopulmonary resuscitation. Simpler criteria as a universal TOR rule may be desirable for any level of EMS personnel. We performed this study to validate two TOR rules and a modified BLS TOR rule which includes three criteria: unwitnessed arrest, no shocks administered and no ROSC achieved before arrival at hospital for predicting refractory OHCAs.

Highlights

Sepsis is primarily a disease of the aged and 60% of sepsis occurs in patients older than 65 years, 80% of deaths due to sepsis occur in this age group
The purpose of the study is to elucidate the immunological changes that occur in Klotho mice after sepsis in order to identify therapeutic targets for sepsis that occurs in aged individuals
Poor survival in Klotho-septic mice may be associated with impaired bacterial clearance with decreased recruitment of neutrophils/macrophages in peritoneal cavity, elevated cytokines in serum, and increased apoptosis in thymus and spleen, following to impaired innate and adaptive immunity

Summary

Introduction

Sepsis is primarily a disease of the aged and 60% of sepsis occurs in patients older than 65 years, 80% of deaths due to sepsis occur in this age group. The aim of this study was to determine the reasons behind out-of-hours discharges in our hospital and the effect this has on mortality This audit reviewed the discharge process of patients from an adult general ICU to the general wards before and after the introduction of a liaison nurse post over a 3-year, 3-month time period. The aim of this study was to establish and compare the quality and value of the summaries as judged by ICU doctors and GPs. The relationship between provider volume and patient outcome has been demonstrated for many medical and surgical services, including critical care. Methods In this single-centre observational study we aimed to quantify functional dependency at three different time points: discharge from ICU (DI), discharge from hospital (DH) and discharge from nursing home rehabilitation unit (DR) To this end we retrospectively assed Barthel scores (BS) for individual patients [1], with a duration of mechanical ventilation >48 hours.

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