PREDICTING THE OUTCOME OF UNSUCCESSFUL PREHOSPITAL ADVANCED CARDIAC LIFE-SUPPORT

Objective.-To determine if failure to achieve return of spontaneous ci rculation following prehospital advanced cardiac life support (ACLS) w arrants termination of efforts at the scene. Design.-Retrospective cas e series. Setting.-Memphis, Tenn, a city of 610337 people that is serv ed by a fire department-based emergency medical service system. All ci ty ambulances provide ACLS. Patients.-Adult victims of out-of-hospital cardiac arrest due to heart disease. Intervention.-All patients recei ved prehospital ACLS according to the 1986 American Heart Association guidelines. Following prehospital ACLS, all patients were transported to the nearest hospital emergency department whether or not a pulse wa s restored in the field. Main Outcome Measures.-Survival to hospital a dmission, survival to hospital discharge, and neurological status at d ischarge. Results.-Over the 39-month study interval, the Memphis Fire Department treated 1068 victims of out-of-hospital cardiac arrest. Thr ee hundred ten of these (29%) had return of spontaneous circulation pr ior to transport for some period. The remaining 758 patients (71%) nev er regained a pulse and were transported with ongoing cardiopulmonary resuscitation. Patients who had return of spontaneous circulation prio r to transport were more likely to be admitted (69% vs 7.0%) and far m ore likely to be discharged alive (26.5% vs 0.4%) than patients who fa iled to respond to prehospital ACLS. Three patients who survived to ho spital discharge despite failure to achieve return of spontaneous circ ulation prior to emergency medical service transport sustained their c ardiac arrest after paramedic arrival. All three were discharged with moderate to severe cerebral disability. Conclusion.-Rapid transport of adults who fail to respond to an adequate trial of prehospital ACLS d oes not result in meaningful rates of survival. In such cases, on-line emergency medical service physicians should authorize paramedics to c ease efforts in the field.