A few states have pediatric out of hospital termination of resuscitation protocols. This study used CARES data to create a termination protocol that was not only linked to ROSC, but also to neurological outcomes. This study only included medical arrests.
21240 children were included in the study where 2326 patients survived to hospital discharge. A total of 1894 survived with a favorable neurological outcome. The criteria developed for pediatric TOR in this study had a specificity of 99.1% and a PPV of 99.8% for patient death. Another set of criteria had a 99.7% specificity and PPV of 99.9% for predicting death or survival with poor neurological outcome.
TOR criteria of death consisted of:
unwitnessed arrest
asystole
arrest not due to drowning or electrocution
no sustained ROSC
TOR criteria of death or survival with poor neurological outcome:
unwitnessed arrest
asystole
arrest not due to drowning or electrocution
no sustained ROSC
no bystander CPR
Bottom line: Pediatric termination of resuscitation in the out of hospital setting can be appropriate under the right set of conditions.
References
Shetty P, Ren Y, Dillon D, et al. Derivation of a clinical decision rule for termination of resuscitation in non-traumatic pediatric out-of-hospital cardiac arrest. Resuscitation. Published online September 18, 2024. doi:10.1016/j.resuscitation.2024.110400
