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In Reply: We agree with Dr Sasson and colleagues and the 2005 American Heart Association Guidelines¹ cited in our Editorial that patients in cardiac arrest unresponsive to CPR and advanced cardiac life support in the out-of-hospital setting do not need to be transported to a hospital.¹ This is consistent with the clinical practice at the University of Arizona Sarver Heart Center. However, we do not feel that a termination-of-resuscitation (TOR) rule is necessary for a team of well-educated health care professionals to determine that the patient will not respond to further resuscitation treatment. Clinicians make the decision to terminate resuscitation for both in-hospital and out-of-hospital cardiac arrest based on individual patient factors, local system factors, and arrest factors and circumstances. Clinicians must have knowledge of the prognostic factors for survival as well as changes in the science of resuscitation.

We have a number of concerns about recommending a universal TOR . . . [Full Text of this Article]

Arthur B. Sanders, MD
art@aemrc.arizona.edu
Department of Emergency Medicine

Karl B. Kern, MD
Department of Internal Medicine
University of Arizona Sarver Heart Center
Tucson

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