• Atsunori Onoe, Kentaro Kajino, Mohamud R Daya, OngMarcus Eng HockMEHDepartment of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore., Fumiko Nakamura, Mari Nakajima, Hiroki Takahashi, Masanobu Kishimoto, Kazuhito Sakuramoto, Takashi Muroya, Hitoshi Ikegawa, and Yasuyuki Kuwagata.
• Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan. Electronic address: onoeat@hirakata.kmu.ac.jp.
• Resuscitation. 2021 May 1; 162: 245-250.

BackgroundCorrect identification of futile prehospital resuscitation for out-of-hospital cardiac arrest (OHCA) may reduce unnecessary transports. Prehospital return of spontaneous circulation (ROSC) is considered by many to be an important predictor of outcome. The purpose of this study was to evaluate OHCA victims without prehospital ROSC characteristics and their outcomes in relation to the universal Termination of Resuscitation (TOR) rule.MethodsA retrospective, population-based review of OHCA victims without prehospital ROSC from January 1, 2010 to December 31, 2017 in the All-Japan Utstein Registry. We compared those that met the universal TOR rule and those that did not for the primary outcome: one-month survival with neurologically favorable Cerebral Performance Category (CPC) 1 or 2.Results989,929 OHCA cases, 18 years of age or older, were registered in the All-Japan Utstein Registry and 525,801 cases were of presumed cardiac origin and had no prehospital ROSC. Of these, the one-month CPC was 1 or 2 for 3957 cases (0.8%). In the 'no ROSC' group who also met the TOR rule, the number of cases was 433,571 with a one-month survival of 0.9% (3799 cases), and the proportion with a CPC 1or 2 was 0.2% (699 cases).ConclusionsContinued resuscitation and transport of cases with no field ROSC who fulfill the TOR rule is futile and could be considered for adoption in Japan.Copyright © 2021 Elsevier B.V. All rights reserved.

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