Basic Life Support Termination of Resuscitation Implementation Study

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Dr. Laurie Morrison, Sunnybrook Health Sciences Centre
ClinicalTrials.gov Identifier:
NCT00370461
First received: August 29, 2006
Last updated: June 12, 2012
Last verified: December 2009
  Purpose

In Ontario, most people who experience a cardiac arrest at home (when their heart stops beating) only receive basic life support from Primary Care Paramedics (PCPs) and all are transported to the hospital. Most are pronounced dead by the emergency physician as the mean survival rate for these patients is 5%. Allowing Primary Care Paramedics to use a termination of resuscitation guideline would identify futile cases for which further resuscitation is unwarranted and decrease the number of patients being transported to the emergency department (ED) for pronouncement.

There are numerous advantages to this strategy; first, it may improve the efficiency of the ED because cardiac arrest patients require immediate attention that is diverted from patients who have a better chance at survival. Second, the risk of injury and the monetary costs for the paramedic and the public would be minimized with fewer "light and sirens" transports which are known to be hazardous to motorists, pedestrians, and Emergency Medical Services (EMS) personnel.

For each cardiac arrest, PCPs will respond to the call as usual and implement standard basic life support cardiac arrest protocols. Patients are then categorized according to the termination of resuscitation recommendations:

  1. no return of spontaneous circulation is achieved (no heartbeat);
  2. no shock was given prior to transport; and
  3. the arrest (when the heart stops beating) was not witnessed by EMS personnel.

If all of these criteria are true, the PCP will contact the hospital and the decision by the emergency physician will then be made to stop life saving measures (terminate resuscitation) in the home or continue with life support and transport the patient to the local emergency department.

This study aims to document the usefulness of the termination of the resuscitation guideline in decreasing the rate of transport of out-of-hospital cardiac arrest patients to the ED. Secondary aims of this implementation study will be to describe the rates of erroneous application of the guideline. The comfort of use of the rule among paramedics and base hospital emergency physicians will be described.


Condition
Cardiac Arrest

Study Type: Observational
Study Design: Observational Model: Case-Only
Time Perspective: Prospective
Official Title: Basic Life Support Termination of Resuscitation in the Prehospital Environment for Primary Care Paramedics - A Prospective Observational Study of the Implementation of a Clinical Prediction Rule

Resource links provided by NLM:


Further study details as provided by Sunnybrook Health Sciences Centre:

Enrollment: 350
Study Start Date: January 2006
Study Completion Date: June 2012
Primary Completion Date: December 2010 (Final data collection date for primary outcome measure)
  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population

This is a multi centre prospective observational study of the implementatiaon of a Basic Life Support Termination of Resuscitation(BLS TOR)guideline.The study will accrue all out of hospital cardiac arrest cases from 9 regions across the province of Ontario(Cornwall, Hamilton,Peel, Peterborough, Grey Bruce Huron, Timmins, Sault Ste Marie, Simcoe/Muskoka, Cambridge). There are 22 participating EMS systems over the 9 regions.

Criteria

Inclusion Criteria:

  • Age > 18
  • No advanced cardiac life support procedures (ACLS) were available during the call
  • The cardiac arrest is of presumed cardiac cause only

Exclusion Criteria:

  • Age < 18
  • The patient possesses a documented do-not-resuscitate (DNR) order
  • The cardiac arrest is due to non cardiac causes such as trauma, drowning or drug overdose
  • Patient receives any prehospital ACLS care
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00370461

Locations
Canada, Ontario
Royal Victoria Hospital
Barrie, Ontario, Canada, L4N 1K4
Cornwall Community Hospital
Cornwall, Ontario, Canada, K6H 1Z6
Hamilton Health Sciences
Hamilton, Ontario, Canada, L8V 1C3
Grey Bruce Huron
Owen Sound, Ontario, Canada, N4K 6M9
Peterborough Regional Health Center
Peterborough, Ontario, Canada, K9J 7C6
Sault Area Hospital
Sault Ste Marie, Ontario, Canada, P6A 2C4
Timmins and District Hospital
Timmins, Ontario, Canada, P4N 8P2
Sponsors and Collaborators
Sunnybrook Health Sciences Centre
Investigators
Principal Investigator: Laurie J Morrison, MD Rescu, St. Michael's Hospital Toronto
Principal Investigator: Richard P Verbeek, MD Division of Emergency Medicine, Department of Medicine, University of Toronto and Sunnybrook Osler Center for Prehospital Care
Principal Investigator: Don Eby, MD Grey Bruce Huron Paramedic Base Hospital Program, Grey Bruce Health Services, Owen Sound Hospital
  More Information

Publications:
Responsible Party: Dr. Laurie Morrison, Clinician Scientist, Sunnybrook Health Sciences Centre
ClinicalTrials.gov Identifier: NCT00370461     History of Changes
Other Study ID Numbers: MOP67110
Study First Received: August 29, 2006
Last Updated: June 12, 2012
Health Authority: Canada: Canadian Institutes of Health Research

Keywords provided by Sunnybrook Health Sciences Centre:
Basic Cardiac Life Support
Termination of Resuscitation
Emergency Medical Services
Primary Care Paramedics
Out of Hospital Cardiac Arrest

Additional relevant MeSH terms:
Heart Arrest
Heart Diseases
Cardiovascular Diseases

ClinicalTrials.gov processed this record on August 19, 2014