Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for diferent resuscitation protocols

Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for diferent resuscitation protocols

Out-of-hospital cardiac arrest, Predictive performance, Termination of resuscitation, Resuscitation, Basic
life support, Advanced life support

Background: Resuscitation guidance has advanced; however, the predictive performance of the termination of
resuscitation (TOR) rule has not been validated for diferent resuscitation protocols published by the American Heart
Association (AHA).
Methods: A retrospective study validating the basic life support (BLS) and advanced life support (ALS) TOR rules was
conducted using an Utstein-style database in Tainan city, Taiwan. Adult patients with nontraumatic out-of-hospital
cardiac arrests from January 1, 2015, to December 31, 2015, (using the AHA 2010 resuscitation protocol) and from
January 1, 2020, to December 31, 2020, (using the AHA 2015 resuscitation protocol) were included. The characteristics
of rule performance were calculated, including sensitivity, specifcity, positive predictive value (PPV) and negative
predictive value.
Results: Among 1260 eligible OHCA patients in 2015, 757 met the BLS TOR rule and 124 met the ALS TOR rule. The
specifcity and PPV for predicting unfavorable neurological outcomes were 61.1% and 99.0%, respectively, for the BLS
TOR rule and 93.8% and 99.2%, respectively, for the ALS TOR rule. A total of 970 OHCA patients were enrolled in 2020,
of whom 438 met the BLS TOR rule and 104 met the ALS TOR rule. The specifcity and PPV for predicting unfavorable
neurological outcomes were 85.7% and 100%, respectively, for the BLS TOR rule and 99.5% and 100%, respectively, for
the ALS TOR rule.
Conclusions: Both the BLS and ALS TOR rules performed better when using the 2015 AHA resuscitation protocols
compared to the 2010 protocols, with increased PPVs and decreased false-positive rates in predicting survival to
discharge and good neurological outcomes at discharge. The BLS and ALS TOR rules can perform diferently while
the resuscitation protocols are updated. As the concepts and practices of resuscitation progress, the BLS and ALS TOR
rules should be evaluated and validated accordingly.

Yu‑Yuan Lin, Yin‑Yu Lai, Hung‑Chieh Chang, Chien‑Hsin Lu, Po‑Wei Chiu, Yuh‑Shin Kuo, Shao‑Peng Huang, Ying‑Hsin Chang and Chih‑Hao Lin

BMC Emergency Medicine

(2022) 22:53

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