A hypothetical implementation of 'Termination of Resuscitation' protocol for out-of-hospital cardiac arrest.
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2021-06
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Abstract
Background
Out-of-hospital cardiac arrests with negligible chance of survival are routinely transported to hospital and many are pronounced dead thereafter. This leads to some potentially avoidable costs. The 'Termination of Resuscitation' protocol allows paramedics to terminate resuscitation efforts onsite for medically futile cases. This study estimates the changes in frequency of costly events that might occur when the protocol is applied to out-of-hospital cardiac arrests, as compared to existing practice.Methods
We used Singapore data from the Pan-Asian Resuscitation Outcomes Study, from 1 Jan 2014 to 31 Dec 2017. A Markov model was developed to summarise the events that would occur in two scenarios, existing practice and the implementation of a Termination of Resuscitation protocol. The model was evaluated for 10,000 hypothetical patients with a cycle duration of 30 days after having a cardiac arrest. Probabilistic sensitivity analysis accounted for uncertainties in the outcomes: number of urgent transports and emergency treatments, inpatient bed days, and total number of deaths.Results
For every 10,000 patients, existing practice resulted in 1118 (95% Uncertainty Interval 1117 to 1119) additional urgent transports to hospital and subsequent emergency treatments. There were 93 (95% Uncertainty Interval 66 to 120) extra inpatient bed days used, and 3 fewer deaths (95% Uncertainty Interval 2 to 4) in comparison to using the protocol.Conclusion
The findings provide some evidence for adopting the Termination of Resuscitation protocol. This policy could lead to a reduction in costs and non-beneficial hospital admissions, however there may be a small increase in the number of avoidable deaths.Type
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Nazeha, Nuraini, Marcus Eng Hock Ong, Alexander T Limkakeng, Jinny J Ye, Anjni Patel Joiner, Audrey Blewer, Nur Shahidah, Gayathri Devi Nadarajan, et al. (2021). A hypothetical implementation of 'Termination of Resuscitation' protocol for out-of-hospital cardiac arrest. Resuscitation plus, 6. p. 100092. 10.1016/j.resplu.2021.100092 Retrieved from https://hdl.handle.net/10161/23880.
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Anjni Patel Joiner
Anjni Joiner, DO, MPH, FACEP, FAEMS is an Assistant Professor of Emergency Medicine at Duke University School of Medicine. Dr. Joiner serves as Medical Director of Prehospital Medicine at Duke University Hospital, overseeing the Emergency Medical Services section within the Department of Emergency Medicine. She also serves as the Medical Director for Durham County EMS, providing medical oversight to all county agencies, including EMS, first responders, and the Durham Emergency Call Center. In these roles, she strives to work collaboratively with community partners to provide care to underserved and underrepresented populations. These efforts include development of Community Paramedicine programs to address opioid use disorder in Durham Community through harm reduction techniques and partnering with organizations such as the City of Durham HEART team for unarmed police response.
Her research interests include injury prevention and trauma, development and strengthening of prehospital emergency care systems internationally, and improving access to care. Her current projects include a comprehensive assessment of the emergency care system in Moshi, Tanzania through a community needs and hospital capacity assessment and development of a prehospital emergency care system evaluation tool (PECSET) for underdeveloped EMS systems in South and Southeast Asia.
Audrey L Blewer
Audrey L. Blewer, PhD, MPH is an epidemiologist and resuscitation scientist in the Department of Family Medicine and Community Health and Department of Population Health Sciences within Duke University School of Medicine. Dr. Blewer completed her Doctor of Philosophy in Epidemiology at the University of Pennsylvania from the Department of Biostatistics, Epidemiology, and Informatics and her Master of Public Health in Social in Behavioral Sciences from the University of Florida.
Dr. Blewer has published in several noteworthy journals such as Circulation, Lancet Public Health, Circulation Cardiovascular Quality and Outcomes, and Critical Care Medicine. She is recognized in the field of resuscitation science nationally and internationally. Dr. Blewer is contributing to the upcoming American Heart Association Guidelines writing group for Resuscitation Education and serves on the Editorial Board for the journal Resuscitation Plus. Dr. Blewer works on interdisciplinary research projects at both Duke and Duke-NUS Medical Center
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