Futility and Termination of Resuscitation Variation for Pediatric Out-of-Hospital Cardiac Arrest.
Which EMS agency treats a child drives termination-of-resuscitation decisions more than patient factors.
Futility and Termination of Resuscitation Variation for Pediatric Out-of-Hospital Cardiac Arrest.
To evaluate agency-level differences in determinations of futility (defined as withholding resuscitative efforts by emergency medical services [EMS]) and termination of resuscitation (termination of resuscitation) during prehospital encounters for pediatric out-of-hospital cardiac arrest (out-of-hospital cardiac arrest).
We conducted a retrospective cross-sectional study of EMS activations for children (aged <18 years) with nontraumatic out-of-hospital cardiac arrest from the 2018-2023 National EMS Information System.
which ambulance service responds outweighs any patient factor in that choice
We included 45 045 encounters treated by 6550 EMS agencies.
Resuscitation was considered futile in 6.6%; among the remainder, termination of resuscitation occurred in 25.4%.
Termination of resuscitation was less likely among witnessed arrests and noncardiac etiologies.
The median odds ratio for a futility determination was 2.33 (95% CI 2.16-2.47), which exceeded in magnitude the odds ratio for all fixed-effect variables except for arrest witnessed status, etiology of drowning/submersion, bystander cardiopulmonary resuscitation status, tribal-type EMS agency, and wilderness events.
We found substantial agency-level variation in determinations of futility and termination of resuscitation for pediatric out-of-hospital cardiac arrest, underscoring that local EMS practice patterns may shape resuscitation decisions.
These findings carry implications for patient care, resource utilization, and clinical outcomes.