Study Examines Termination of Resuscitation Rules

Holmberg MJ, Granfeldt A, Moskowitz A, et al. Termination of Resuscitation Rules for In-Hospital Cardiac Arrest. JAMA Intern Med. 2025; in press.

Richman IB, Inouye SK, Wang T. Decision Rules for Termination of Resuscitation—A Roadmap for Challenging Terrain. JAMA Intern Med. 2025; in press.

A lack of validated decision rules for termination of resuscitation during in-hospital cardiac arrest may lead to inappropriate early termination of resuscitation. This study used data from national medical databases in Denmark, Sweden, and Norway to determine important components of termination of resuscitation rules.

They identified five important variables: age, initial rhythm, witnessed status, ICU location, and resuscitation duration. Rules with a rate of death prediction in patients who might survive of <1% and a proportion of cases for whom termination was recommended of >10% were considered appropriate for inclusion.

After analysis of the data, four variables were identified for inclusion: unwitnessed and/or unmonitored arrest, asystole rhythm, and duration of resuscitation of more than 10 minutes. These were included in the best performing rule; if all variables were present, termination of resuscitation was deemed appropriate.

The editorial by Richman and coauthors agreed that application of the rule would reduce the risk of early termination of resuscitation. They recommended additional studies in other regions to strengthen the validation of this rule set.