Development of a national consensus guideline for termination of resuscitation in the out-of-hospital environment.
Introduction: Ambulance services in England attempted resuscitation in over 34,400 cases in 2022. Of these, 58% had the resuscitation attempt terminated at the scene and only 7.8% survived to hospital discharge. The decision to stop resuscitation is informed by a national guideline that is over 20 y...
| Publicado en: | British Paramedic Journal Vol. 11; no. 1; pp. 56 - 66 |
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| Autores principales: | , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
College of Paramedics
Jun2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=194277609&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 194277609 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14784726 LFLE jtl: British Paramedic Journal issn: 14784726 maglogo: N pubinfo: dt: Jun2026 vid: 11 iid: 1 pid: 46865 pub: College of Paramedics artinfo: ui: 194277609 194277609 194277609 10.29045/14784726.2026.6.11.1.56 194277609 ppf: 56 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Development of a national consensus guideline for termination of resuscitation in the out-of-hospital environment. aug: au: Smyth, Michael A. Brown, Terry P. Fothergill, Rachael Griffiths, Frances Lall, Ranjit Long, John Petrou, Stavros Siriwardena, Aloysius Niroshan Slowther, Anne-Marie Bettely, Lauren Eli, Karin Gardiner, Galina Huxley, Caroline Khan, Kamran Michelet, Felix Perkins, Gavin D. affil: University of Warwick sug: subj: Heart Arrest Therapy Prehospital Care Resuscitation, Cardiopulmonary Resuscitation Orders Practice Guidelines Consensus Guideline Adherence Human Multimethod Studies Comparative Studies Descriptive Statistics Workflow Professional Practice Ambulances England Sensitivity and Specificity Emergency Service Paramedics Emergency Medical Services Bystander CPR Patient Safety Health Facility Environment Protocols Emergency Responders Treatment Termination Transportation of Patients Decision Making, Clinical Cause of Death Interviews Funding Source ab: Introduction: Ambulance services in England attempted resuscitation in over 34,400 cases in 2022. Of these, 58% had the resuscitation attempt terminated at the scene and only 7.8% survived to hospital discharge. The decision to stop resuscitation is informed by a national guideline that is over 20 years old. This study describes the development of a revised termination of resuscitation (TOR) guideline. Methods: This was a mixed-methods study comprising a diagnostic test accuracy meta-analysis of TOR rules, modelling of multiple TOR rules using data from the Out-of-Hospital Cardiac Arrest Outcomes registry, a survey of ambulance services including a review of national policy documents, qualitative interviews with ambulance and emergency department (ED) clinicians, plus interviews with relatives of patients who did not survive a pre-hospital resuscitation attempt. These work packages informed a national consensus meeting with a wide range of stakeholders, employing nominal group techniques, to draft a revised TOR guideline. Results: The systematic review identified very low-certainty evidence from 43 studies, indicating that TOR rules are unlikely to be suitable for implementation in the UK. When we modelled the performance of TOR rules, the three best performing were the Marsden, KOCARC 1 and GOTO1 TOR rules. We identified considerable variation in practice across UK ambulance services; however, there was consistency across services with respect to perceived risks. Paramedics experienced tension when they felt that guidelines restricted them from acting in the patient's best interests. ED staff felt that paramedics should be empowered to stop resuscitation in some cases. Relatives felt that paramedics did a good job and that they had information that was useful for paramedics. Multiple stakeholders participated in a consensus conference to develop a revised TOR guideline. Conclusion: We iteratively derived updated TOR and verification of death guidelines. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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