Abstract

Introduction: Termination of resuscitation guidelines for out-of-hospital cardiac arrest can identify patients in
whom continuing resuscitation has little chance of success. This study examined the outcomes of patients
transferred to hospital with ongoing CPR. It assessed outcomes for those who would have met the universal
prehospital termination of resuscitation criteria (no shocks administered, unwitnessed by emergency medical
services, no return of spontaneous circulation).
Methods: A retrospective cohort study of consecutive adult patients who were transported to hospital with
ongoing CPR was conducted at three hospitals in the West Midlands, UK between September 2016 and
November 2017. Patient characteristics, interventions and response to treatment (ROSC, survival to discharge)
were identified.
Results: 227 (median age 69 years, 67.8% male) patients were identified. 89 (39.2%) met the universal prehospital
termination of resuscitation criteria. Seven (3.1%) were identified with a potentially reversible cause of
cardiac arrest. After hospital arrival, patients received few specialist interventions that were not available in the
prehospital setting. Most (n=210, 92.5%) died in the emergency department. 17 were admitted (14 to intensive
care), of which 3 (1.3%) survived to hospital discharge. There were no survivors (0%) in those who met the
criteria for universal prehospital termination of resuscitation.
Conclusion: Overall survival amongst patients transported to hospital with ongoing CPR was very poor.
Application of the universal prehospital termination of resuscitation rule, in patients without obvious reversible
causes of cardiac arrest, would have allowed resuscitation to have been discontinued at the scene for 39.2% of
patients who did not survive.