Factors associated with initiation of medical advanced cardiac life support after out-of-hospital cardiac arrest

Jean-Christophe Orban, Didier Giolito, Jordan Tosi, Franck Le Duff, Nicolas Boissier, Christophe Mamino, Emmanuelle Molinatti, Thai Se Ung, Yassine Kabsy, Nicolas Fraimout, Julie Contenti, Jacques Levraut

Termination of resuscitation rule permits to stop futile resuscitative efforts by paramedics. In a different setting, the decision to withhold resuscitation by emergency physician could be based on different factors. We aimed to identify the factors associated with the initiation of a medical ACLS in out-of-hospital cardiac arrest patients. We prospectively collected the characteristics of all out-of hospital cardiac arrest patients occurring in a French district between March 2010 and December 2013 and managed by the emergency medical system. We analyzed the factors associated with the initiation of medical ACLS. Medical ACLS was initiated in 69 % of the 2690 patients included in the register. ACLS patients were younger (69 years [55-80] vs. 84 years [77-90]) and more frequently men. A higher percentage of witnessed cardiac arrest and BLS were observed. Duration of no-flow was shorter in the ACLS patients, whereas BLS duration was longer. A higher proportion of shockable rhythm and application of AED were found in this group. Mains factors associated with the initiation of medical ACLS were a suspected cardiac cause (1.73 [1.30-2.30]) and use of an automated external defibrillator (1.59 [1.18-2.16]), whereas factors associated with no medical ACLS were higher age (0.93 [0.92-0.94]), absence of BLS (0.62 [0.52-0.73]), asystole (0.31 [0.18-0.51]) and location in nursing home (0.23 [0.11-0.51]). The medical decision to not initiate ACLS in out-of-hospital cardiac arrest patients seems to rely on a complex combination of validated criteria used for termination of resuscitation and factors resulting from an intuitive perception of the outcome.