New Rules for Calling Codes in the Field

[docB]

Interesting article in Emergency Physicians Monthly (which is not a peer reviewed journal, it's more of an ER doctor news magazine) titled Pre-Hospital Cardiac Arrest: When to Pull the Plug.

It suggests that the existing data supports using the following rule to call a code in the field:

The ALS-TOR [Termination of Resuscitation] rule recommends termination of resuscitation when:
-No AED shocks are administered prior to transport,
-No return of spontaneous circulation (ROSC) occurs,
-The arrest is not witnessed by either EMS personnel or bystanders, and
-No bystander CPR is administered.

It's interesting as it's much more liberal than most existing termination criteria.

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[jbar]

That's pretty much what we used in the field. Since it says for non shockable rhythms you are really talking about PEA and asystole. We would give two rounds of drugs for asystole and then call it. In the field at least it seemed that PEA would either go to ROSC or devolve into asystole in which you are back in the first criteria.

Interesting that the article doesn't mention if special situations were excluded from the analysis (hypothermia, drowning etc) where the current thought is that they should be worked more aggressively.

 

[csmmedic]

We terminate in my system with :
Traumatic arrest with heavy extrication to be required to gain access
Traumatic arrest with asystole regardless of entrapment
"Medical" arrest with asystole or PEA and no response to good BLS and ACLS Any one with obvious signs of death (the standard incineration, decapitation, rigor, lividity, etc)

 

[leviathan]

I believe there's a study going on in Ontario using this protocol. It's basically 100% sensitive for determining viability.

 

[jbar]

I believe there's a study going on in Ontario using this protocol. It's basically 100% sensitive for determining viability.

You mean after they pronounce someone in the field they are always later determined to be dead?

 

[deleted6669]

You mean after they pronounce someone in the field they are always later determined to be dead?

yup, double blind study.
they take volunteers and cases called in the field and see if the pathologist can tell the difference....

 

[docB]

I believe there's a study going on in Ontario using this protocol. It's basically 100% sensitive for determining viability.

You mean after they pronounce someone in the field they are always later determined to be dead?

yup, double blind study.
they take volunteers and cases called in the field and see if the pathologist can tell the difference....

That was my first thought too (and I laughed). But what this usually means is that they went back and applied the criteria to a bunch of cases that were handled according to whatever the existing system was and then looked to see if the criteria would have called efforts on anyone who turned out to be viable. Their conclusion was that they didn't miss any.

This is how many studies that put forward clinical rules (eg. Nexus neck rules, Ottawa ankle and knee rules, some of the recent pediatric head injury and elderly head injury rules, etc.) are done.

 

[leviathan]

You mean after they pronounce someone in the field they are always later determined to be dead?

They tried to do it that way, but ermm, the ethics committee said it wouldn't be 'kosher'. What DocB said.

 

[jbar]

yeah yeah, I know. Jokes.