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Prehospital termination of resuscitation rule

Morrison, Laurie J.

Current Opinion in Critical Care: June 2019 - Volume 25 - Issue 3 - p 199–203
doi: 10.1097/MCC.0000000000000614

Purpose of review The purpose of the review is to briefly describe the derivation, validation and implementation of the Termination of Resuscitation Rules for out-of-hospital adult cardiac arrest and to describe the controversies surrounding implementation that have been recently published.

Recent findings New guidelines, new interventions that alter baseline survival, the use of eCPR and issues related to duration of CPR have minimal impact on the sustainability and application of the TOR rule.

Some published articles related to using only one criterion in the rule may be cavalier and miss potential survivors.

Decisions based on discretion may cause wide variation in termination rates and evidence-based decision rules are in the best interest of distributive justice for the patient and comfort for the provider.

Summary The Universal Termination of Resuscitation Rule has a built-in sensibility to the introduction of new treatment guidelines, including emphasis on CPR metrics, changes in baseline survival rates, duration of resuscitation and new treatment options including eCPR and postarrest care. As well, the TOR rule continues to address inconsistencies in practice and improve provider comfort.

Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada

Correspondence to Dr Laurie J. Morrison, MD, MSc, FRCPC, Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1M8, Canada. Tel: +1 416 864 6060 x7849; e-mail:

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