• Laurie J Morrison, Don Eby, Precilla V Veigas, Cathy Zhan, Alex Kiss, Vince Arcieri, Paul Hoogeveen, Chris Loreto, Michelle Welsford, Tim Dodd, Elma Mooney, Marty Pilkington, Cathy Prowd, Erica Reichl, Jim Scott, Jeanette M Verdon, Tim Waite, Jason E Buick, and P Richard Verbeek.
• Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute at St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Emergency, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: MorrisonL@smh.ca.
• Resuscitation. 2014 Apr 1;85(4):486-91.

BackgroundThe basic life support (BLS) termination of resuscitation (TOR) rule recommends transport and continued resuscitation when cardiac arrest is witnessed by EMT-Ds, or there is a return of spontaneous circulation, or a shock is given, and prior studies have suggested the transport rate should fall to 37%.Methods And ResultsThis real-time prospective multi-center implementation trial evaluated the BLS TOR rule for compliance, transport rate and provider and physician comfort. Both provider and physician noted their decision-making rationale and ranked their comfort on a 5-point Likert scale. Functional survival was measured at discharge. Of 2421 cardiac arrests, 953 patients were eligible for the rule, which was applied correctly for 755 patients (79%) of which 388 were terminated. 565 patients were transported resulting in a reduction of the transport rate from 100% (historical control) to 59% (p<0.001). The BLS TOR rule was not followed in 198 eligible patients (21%) and they were all transported despite meeting the criteria to terminate. Providers cited 241 reasons for non-compliance: family distress, short transport time interval, younger age and public venue. All 198 transported patients, non-compliant with the rule, died. Both providers and physicians were comfortable with using the rule to guide TOR (median [IQR] of 5 [4,5]; p<0.001).ConclusionsThis implementation trial confirmed the accuracy of the BLS TOR rule in identifying futile out-of-hospital cardiac arrest (OHCA) resuscitations, significantly reduced the transport rate of futile OHCA and most providers and physicians were comfortable following the rule's recommendations.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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