Cardiac arrest & resuscitation
External validation of rules for termination of resuscitation in in-hospital cardiac arrest
Authors' conclusion
In this large American cohort, previously derived termination rules for in-hospital cardiac arrest demonstrated either limited applicability or unacceptable error rates. Even the best-performing Scandinavian rule identified few patients for early termination and would have led to premature cessation in ∼5% of survivors.
Study context
- Population
- Adults (≥18 years) with IHCA, AHA Get With The Guidelines-Resuscitation registry hospitals, 2012–2024
- Participants
- 359,686 adults · 703 hospitals
- Exposure
- Patients meeting vs not meeting previously derived termination of resuscitation rules
- Outcome
- Survival to hospital discharge (positive rates, false positive rates, false discovery rates, resuscitation time potentially avoided)
Methodological detailsexternal validation, prospectively collected registry, multicentre, hypothesis formulated prior to analysis
- External validation
- Prospectively collected registry
- Multicentre
- Hypothesis formulated prior to analysis
Main finding
As reported in the abstract
Primary Scandinavian Rule 1
| Group | Positive rate (patients meeting Rule criteria) | ROSC among those meeting rule | Survived to discharge among those meeting rule |
|---|---|---|---|
| Rule 1 | 1.7% | 32.9% | 5.1% |
Rule 1
Positive rate (patients meeting Rule criteria)1.7%
ROSC among those meeting rule32.9%
Survived to discharge among those meeting rule5.1%
- Overall survival to discharge
- 23.1%
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| Resuscitation time potentially avoided (Rule 1) | Rule 1 median 11 min per patient |
- Resuscitation time potentially avoided (Rule 1) — Per 100 events
- ∼18 min
Positive rates across hospitals (Rule 1)
- Range across hospitals
- 0% to 11.9
Other termination rules
- Either very low average positive rates or unacceptably high survival rates among patients meeting the rule
- <3%
Sensitivity analyses excluding the COVID-19 era
- Findings similar
Original publication
External validation of rules for termination of resuscitation in in-hospital cardiac arrest. Resuscitation. Published 16 February 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →