{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:15:46Z","timestamp":1788221746960,"version":"build-2803163510"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>To evaluate agency-level differences in determinations of futility (defined as withholding resuscitative efforts by emergency medical services [EMS]) and termination of resuscitation (TOR) during prehospital encounters for pediatric out-of-hospital cardiac arrest (OHCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We conducted a retrospective cross-sectional study of EMS activations for children (aged &amp;lt;18 years) with nontraumatic OHCA from the 2018\u20132023 National EMS Information System. Our outcomes of interest were futility and TOR. We constructed mixed-effects models including patient- and agency-level covariables. We quantified the magnitude of agency-level variation using the median odds ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>We included 45\u2009045 encounters treated by 6550 EMS agencies. Resuscitation was considered futile in 6.6%; among the remainder, TOR occurred in 25.4%. Futility determinations were less likely in witnessed arrests, events with bystander cardiopulmonary resuscitation (CPR), public locations, and respiratory\/asphyxia or drowning etiologies and more likely in rural\/wilderness settings and adolescents. TOR was less likely among witnessed arrests and noncardiac etiologies. The median odds ratio for a futility determination was 2.33 (95% CI 2.16\u20132.47), which exceeded in magnitude the odds ratio for all fixed-effect variables except for arrest witnessed status, etiology of drowning\/submersion, bystander CPR status, tribal-type EMS agency, and wilderness events. The median odds ratio for TOR was 3.50 (95% CI 3.32\u20133.72), which exceeded all fixed-effect variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>We found substantial agency-level variation in determinations of futility and TOR for pediatric OHCA, underscoring that local EMS practice patterns may shape resuscitation decisions. These findings carry implications for patient care, resource utilization, and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2026-076981","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:02:59Z","timestamp":1786492979000},"source":"Crossref","is-referenced-by-count":0,"title":["Futility and Termination of Resuscitation Variation for Pediatric Out-of-Hospital Cardiac Arrest"],"prefix":"10.1542","volume":"158","author":[{"given":"Sriram","family":"Ramgopal","sequence":"first","affiliation":[{"name":"1Division of Pediatric Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Loftus","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Amagasa","sequence":"additional","affiliation":[{"name":"2Department of Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"Kelly","sequence":"additional","affiliation":[{"name":"3Division of Emergency Medicine, Children\u2019s Hospital of Michigan, Central Michigan University, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirupama","family":"Kannikeswaran","sequence":"additional","affiliation":[{"name":"3Division of Emergency Medicine, Children\u2019s Hospital of Michigan, Central Michigan University, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Jaeger","sequence":"additional","affiliation":[{"name":"4Division of Pediatric Emergency Medicine, Children\u2019s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Berg","sequence":"additional","affiliation":[{"name":"5Department of Anesthesiology and Critical Care Medicine, Children\u2019s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caleb E.","family":"Ward","sequence":"additional","affiliation":[{"name":"6Children\u2019s National Hospital & The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Martin-Gill","sequence":"additional","affiliation":[{"name":"7Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Okubo","sequence":"additional","affiliation":[{"name":"7Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"issue":"8","key":"2026083119572526800_r1","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1161\/CIR.0000000000001303","article-title":"2025 heart disease and stroke statistics: a report of US and global data from the American Heart Association","volume":"151","author":"Martin","year":"2025","journal-title":"Circulation."},{"key":"2026083119572526800_r2","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.resuscitation.2018.01.040","article-title":"Epidemiology and outcome of paediatric out-of-hospital cardiac arrests: a paediatric sub-study of the Pan-Asian Resuscitation Outcomes Study (PAROS)","volume":"125","author":"Tham","year":"2018","journal-title":"Resuscitation."},{"issue":"20","key":"2026083119572526800_r3","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1056\/NEJM199611143352001","article-title":"Outcome of out-of-hospital cardiac or respiratory arrest in children","volume":"335","author":"Schindler","year":"1996","journal-title":"N Engl J Med."},{"key":"2026083119572526800_r4","article-title":"Model EMS Clinical Guidelines","author":"National Association of State EMS Officials","year":"2025"},{"key":"2026083119572526800_r5","doi-asserted-by":"crossref","first-page":"110400","DOI":"10.1016\/j.resuscitation.2024.110400","article-title":"Derivation of a clinical decision rule for termination of resuscitation in non-traumatic pediatric out-of-hospital cardiac arrest","volume":"204","author":"Shetty","year":"2024","journal-title":"Resuscitation."},{"key":"2026083119572526800_r6","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.resuscitation.2021.09.015","article-title":"Applying a set of termination of resuscitation criteria to paediatric out-of-hospital cardiac arrest","volume":"169","author":"Harris","year":"2021","journal-title":"Resuscitation."},{"issue":"2","key":"2026083119572526800_r7","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.resuscitation.2003.09.013","article-title":"The perspective of paramedics about on-scene termination of resuscitation efforts for pediatric patients","volume":"60","author":"Hall","year":"2004","journal-title":"Resuscitation."},{"issue":"1","key":"2026083119572526800_r8","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12245-020-0263-6","article-title":"Factors influencing termination of resuscitation in children: a qualitative analysis","volume":"13","author":"Campwala","year":"2020","journal-title":"Int J Emerg Med."},{"issue":"7","key":"2026083119572526800_r9","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1097\/PEC.0000000000001191","article-title":"An ethical justification for termination of resuscitation protocols for pediatric patients","volume":"33","author":"Mu\u00f1oz","year":"2017","journal-title":"Pediatr Emerg Care."},{"issue":"1","key":"2026083119572526800_r10","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s12873-023-00851-5","article-title":"Systemic review of age brackets in pediatric emergency medicine literature and the development of a universal age classification for pediatric emergency patients - the Munich Age Classification System (MACS)","volume":"23","author":"Althammer","year":"2023","journal-title":"BMC Emerg Med."},{"issue":"11","key":"2026083119572526800_r11","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1377\/hlthaff.2014.0679","article-title":"The child opportunity index: improving collaboration between community development and public health","volume":"33","author":"Acevedo-Garcia","year":"2014","journal-title":"Health Aff (Millwood)."},{"key":"2026083119572526800_r12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resuscitation.2015.06.012","article-title":"Time on the scene and interventions are associated with improved survival in pediatric out-of-hospital cardiac arrest","volume":"94","author":"Tijssen","year":"2015","journal-title":"Resuscitation."},{"issue":"6","key":"2026083119572526800_r13","doi-asserted-by":"crossref","first-page":"e2025073047","DOI":"10.1542\/peds.2025-073047","article-title":"Patient and emergency medical services agency factors associated with quality care for children","volume":"156","author":"Ward","year":"2025","journal-title":"Pediatrics."},{"issue":"20","key":"2026083119572526800_r14","doi-asserted-by":"crossref","first-page":"3257","DOI":"10.1002\/sim.7336","article-title":"Intermediate and advanced topics in multilevel logistic regression analysis","volume":"36","author":"Austin","year":"2017","journal-title":"Stat Med."},{"key":"2026083119572526800_r15","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.resuscitation.2021.09.004","article-title":"Emergency medical services employing intra-arrest transport less frequently for out-of-hospital cardiac arrest have higher survival and favorable neurological outcomes","volume":"168","author":"Grunau","year":"2021","journal-title":"Resuscitation."},{"issue":"3","key":"2026083119572526800_r16","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.resuscitation.2010.10.022","article-title":"Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium: ROC Epistry-Cardiac Arrest","volume":"82","author":"Zive","year":"2011","journal-title":"Resuscitation."},{"key":"2026083119572526800_r17","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.resuscitation.2021.05.005","article-title":"To transport or to terminate resuscitation on-site. What factors influence EMS decisions in patients without ROSC? A mixed-methods study","volume":"164","author":"de Graaf","year":"2021","journal-title":"Resuscitation."},{"key":"2026083119572526800_r18","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.resuscitation.2016.07.244","article-title":"Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America","volume":"107","author":"Fink","year":"2016","journal-title":"Resuscitation."},{"issue":"7","key":"2026083119572526800_r19","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1080\/10903127.2022.2128484","article-title":"Emergency medical services leadership perspectives on implementation of evidence-based guidelines: a qualitative study","volume":"27","author":"Guerrier","year":"2023","journal-title":"Prehosp Emerg Care."},{"key":"2026083119572526800_r20","doi-asserted-by":"crossref","first-page":"100397","DOI":"10.1016\/j.resplu.2023.100397","article-title":"Prehospital transport and termination of resuscitation of cardiac arrest patients: a review of prehospital care protocols in the United States","volume":"14","author":"Li","year":"2023","journal-title":"Resusc Plus."},{"issue":"3","key":"2026083119572526800_r21","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1080\/10903120802706161","article-title":"Simulation-based assessment of paramedic pediatric resuscitation skills","volume":"13","author":"Lammers","year":"2009","journal-title":"Prehosp Emerg Care."},{"issue":"1","key":"2026083119572526800_r22","doi-asserted-by":"crossref","first-page":"43","DOI":"10.3109\/10903127.2011.614048","article-title":"The association between EMS workplace safety culture and safety outcomes","volume":"16","author":"Weaver","year":"2012","journal-title":"Prehosp Emerg Care."},{"issue":"5","key":"2026083119572526800_r23","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1080\/10903127.2022.2074180","article-title":"Identification of factors associated with return of spontaneous circulation after pediatric out-of-hospital cardiac arrest using natural language processing","volume":"27","author":"Harris","year":"2023","journal-title":"Prehosp Emerg Care."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2026-076981\/1951956\/pediatrics.2026076981.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2026-076981\/1951956\/pediatrics.2026076981.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T23:57:37Z","timestamp":1788220657000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/158\/3\/e2026076981\/208542\/Futility-and-Termination-of-Resuscitation"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,8,12]]},"published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2026-076981","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"article-number":"e2026076981"}}