Current termination of resuscitation (TOR) guidelines predict neurologically favorable outcome in Japan

Kentaro Kajino, Tetsuhisa Kitamura, Taku Iwami, Mohamud Ramzan Daya, Marcus Eng Hock Ong, Atsushi Hiraide, Takeshi Shimazu, Masashi Kishi, Shigeru Yamayoshi

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: It is unclear whether the basic life support (BLS) and advanced life support (ALS) pre-hospital termination of resuscitation (TOR) rules developed in North America can be applied successfully to patients with out-of-hospital cardiac arrest (OHCA) in other countries. Objectives: To assess the performance of the BLS and ALS TOR in Japan. Methods: Retrospective nationwide, population-based, observational cohort study of consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2009 in Japan. The BLS TOR rule has 3 criteria whereas the ALS TOR rule includes 2 additional criteria. We extracted OHCA patients meeting all criteria for each TOR rule, and calculated the specificity and positive predictive value (PPV) of each TOR rule for identifying OHCA patients who did not have neurologically favorable one-month survival. Results: During the study-period, 151,152 cases were available to evaluate the BLS TOR rule, and 137,986 cases to evaluate the ALS TOR rule. Of 113,140 patients that satisfied all three criteria for the BLS TOR rule, 193 (0.2%) had a neurologically favorable one-month survival. The specificity of BLS TOR rule was 0.968 (95% CI: 0.963-0.972), and the PPV was 0.998 (95% CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival. Of 41,030 patients that satisfied all five criteria for the ALS TOR rule, just 37 (0.1%) had a neurologically favorable one-month survival. The specificity of ALS TOR rule was 0.981 (95% CI: 0.973-0.986), and the PPV was 0.999 (95% CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival. Conclusions: The prehospital BLS and ALS TOR rules performed well in Japan with high specificity and PPV for predicting lack of neurologically favorable one-month survival in Japan. However, the specificity and PPV were not 1000 and we have to develop more specific TOR rules.

Original languageEnglish (US)
Pages (from-to)54-59
Number of pages6
JournalResuscitation
Volume84
Issue number1
DOIs
StatePublished - Jan 2013

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Resuscitation
Japan
Guidelines
Out-of-Hospital Cardiac Arrest
Survival
Emergency Responders
North America
Observational Studies
Cohort Studies

Keywords

  • Advanced Life Support (ALS)
  • Basic life support (BLS)
  • Out-of-hospital cardiac arrest (OHCA)
  • Positive predictive value (PPV)
  • Specificity
  • Termination of resuscitation (TOR)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

Current termination of resuscitation (TOR) guidelines predict neurologically favorable outcome in Japan. / Kajino, Kentaro; Kitamura, Tetsuhisa; Iwami, Taku; Daya, Mohamud Ramzan; Ong, Marcus Eng Hock; Hiraide, Atsushi; Shimazu, Takeshi; Kishi, Masashi; Yamayoshi, Shigeru.

In: Resuscitation, Vol. 84, No. 1, 01.2013, p. 54-59.

Research output: Contribution to journalArticle

Kajino, K, Kitamura, T, Iwami, T, Daya, MR, Ong, MEH, Hiraide, A, Shimazu, T, Kishi, M & Yamayoshi, S 2013, 'Current termination of resuscitation (TOR) guidelines predict neurologically favorable outcome in Japan', Resuscitation, vol. 84, no. 1, pp. 54-59. https://doi.org/10.1016/j.resuscitation.2012.05.027
Kajino, Kentaro ; Kitamura, Tetsuhisa ; Iwami, Taku ; Daya, Mohamud Ramzan ; Ong, Marcus Eng Hock ; Hiraide, Atsushi ; Shimazu, Takeshi ; Kishi, Masashi ; Yamayoshi, Shigeru. / Current termination of resuscitation (TOR) guidelines predict neurologically favorable outcome in Japan. In: Resuscitation. 2013 ; Vol. 84, No. 1. pp. 54-59.
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abstract = "Background: It is unclear whether the basic life support (BLS) and advanced life support (ALS) pre-hospital termination of resuscitation (TOR) rules developed in North America can be applied successfully to patients with out-of-hospital cardiac arrest (OHCA) in other countries. Objectives: To assess the performance of the BLS and ALS TOR in Japan. Methods: Retrospective nationwide, population-based, observational cohort study of consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2009 in Japan. The BLS TOR rule has 3 criteria whereas the ALS TOR rule includes 2 additional criteria. We extracted OHCA patients meeting all criteria for each TOR rule, and calculated the specificity and positive predictive value (PPV) of each TOR rule for identifying OHCA patients who did not have neurologically favorable one-month survival. Results: During the study-period, 151,152 cases were available to evaluate the BLS TOR rule, and 137,986 cases to evaluate the ALS TOR rule. Of 113,140 patients that satisfied all three criteria for the BLS TOR rule, 193 (0.2{\%}) had a neurologically favorable one-month survival. The specificity of BLS TOR rule was 0.968 (95{\%} CI: 0.963-0.972), and the PPV was 0.998 (95{\%} CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival. Of 41,030 patients that satisfied all five criteria for the ALS TOR rule, just 37 (0.1{\%}) had a neurologically favorable one-month survival. The specificity of ALS TOR rule was 0.981 (95{\%} CI: 0.973-0.986), and the PPV was 0.999 (95{\%} CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival. Conclusions: The prehospital BLS and ALS TOR rules performed well in Japan with high specificity and PPV for predicting lack of neurologically favorable one-month survival in Japan. However, the specificity and PPV were not 1000 and we have to develop more specific TOR rules.",
keywords = "Advanced Life Support (ALS), Basic life support (BLS), Out-of-hospital cardiac arrest (OHCA), Positive predictive value (PPV), Specificity, Termination of resuscitation (TOR)",
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T1 - Current termination of resuscitation (TOR) guidelines predict neurologically favorable outcome in Japan

AU - Kajino, Kentaro

AU - Kitamura, Tetsuhisa

AU - Iwami, Taku

AU - Daya, Mohamud Ramzan

AU - Ong, Marcus Eng Hock

AU - Hiraide, Atsushi

AU - Shimazu, Takeshi

AU - Kishi, Masashi

AU - Yamayoshi, Shigeru

PY - 2013/1

Y1 - 2013/1

N2 - Background: It is unclear whether the basic life support (BLS) and advanced life support (ALS) pre-hospital termination of resuscitation (TOR) rules developed in North America can be applied successfully to patients with out-of-hospital cardiac arrest (OHCA) in other countries. Objectives: To assess the performance of the BLS and ALS TOR in Japan. Methods: Retrospective nationwide, population-based, observational cohort study of consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2009 in Japan. The BLS TOR rule has 3 criteria whereas the ALS TOR rule includes 2 additional criteria. We extracted OHCA patients meeting all criteria for each TOR rule, and calculated the specificity and positive predictive value (PPV) of each TOR rule for identifying OHCA patients who did not have neurologically favorable one-month survival. Results: During the study-period, 151,152 cases were available to evaluate the BLS TOR rule, and 137,986 cases to evaluate the ALS TOR rule. Of 113,140 patients that satisfied all three criteria for the BLS TOR rule, 193 (0.2%) had a neurologically favorable one-month survival. The specificity of BLS TOR rule was 0.968 (95% CI: 0.963-0.972), and the PPV was 0.998 (95% CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival. Of 41,030 patients that satisfied all five criteria for the ALS TOR rule, just 37 (0.1%) had a neurologically favorable one-month survival. The specificity of ALS TOR rule was 0.981 (95% CI: 0.973-0.986), and the PPV was 0.999 (95% CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival. Conclusions: The prehospital BLS and ALS TOR rules performed well in Japan with high specificity and PPV for predicting lack of neurologically favorable one-month survival in Japan. However, the specificity and PPV were not 1000 and we have to develop more specific TOR rules.

AB - Background: It is unclear whether the basic life support (BLS) and advanced life support (ALS) pre-hospital termination of resuscitation (TOR) rules developed in North America can be applied successfully to patients with out-of-hospital cardiac arrest (OHCA) in other countries. Objectives: To assess the performance of the BLS and ALS TOR in Japan. Methods: Retrospective nationwide, population-based, observational cohort study of consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2009 in Japan. The BLS TOR rule has 3 criteria whereas the ALS TOR rule includes 2 additional criteria. We extracted OHCA patients meeting all criteria for each TOR rule, and calculated the specificity and positive predictive value (PPV) of each TOR rule for identifying OHCA patients who did not have neurologically favorable one-month survival. Results: During the study-period, 151,152 cases were available to evaluate the BLS TOR rule, and 137,986 cases to evaluate the ALS TOR rule. Of 113,140 patients that satisfied all three criteria for the BLS TOR rule, 193 (0.2%) had a neurologically favorable one-month survival. The specificity of BLS TOR rule was 0.968 (95% CI: 0.963-0.972), and the PPV was 0.998 (95% CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival. Of 41,030 patients that satisfied all five criteria for the ALS TOR rule, just 37 (0.1%) had a neurologically favorable one-month survival. The specificity of ALS TOR rule was 0.981 (95% CI: 0.973-0.986), and the PPV was 0.999 (95% CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival. Conclusions: The prehospital BLS and ALS TOR rules performed well in Japan with high specificity and PPV for predicting lack of neurologically favorable one-month survival in Japan. However, the specificity and PPV were not 1000 and we have to develop more specific TOR rules.

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KW - Basic life support (BLS)

KW - Out-of-hospital cardiac arrest (OHCA)

KW - Positive predictive value (PPV)

KW - Specificity

KW - Termination of resuscitation (TOR)

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