Basic Life Support Termination of Resuscitation Implementation Study
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:
- no return of spontaneous circulation is achieved (no heartbeat);
- no shock was given prior to transport; and
- 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.
|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|
|Study Start Date:||January 2006|
|Study Completion Date:||June 2012|
|Primary Completion Date:||December 2010 (Final data collection date for primary outcome measure)|
Please refer to this study by its ClinicalTrials.gov identifier: NCT00370461
|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|
|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|