Many out-of-hospital cardiac arrests have virtually no chance of meaningful survival, yet current practice often involves transporting these patients to hospital, where death is subsequently pronounced. This process generates potentially avoidable resource utilization and costs. Termination of Resuscitation (TOR) protocols empower paramedics to discontinue resuscitation efforts at the scene in cases deemed medically futile. This study quantifies the differences in resource-intensive events and outcomes between routine transport (current practice) and the application of a validated TOR protocol. Data were drawn from the Singapore cohort of the Pan-Asian Resuscitation Outcomes Study (PAROS) registry between 1 January 2014 and 31 December 2017. A Markov decision model was constructed to simulate clinical pathways and resource use under two strategies: (1) existing practice (universal transport) and (2) implementation of a TOR protocol. The model was run on a hypothetical cohort of 10,000 OHCA patients over a 30-day post-arrest cycle. Probabilistic sensitivity analysis was performed to address parameter uncertainty, with key outcomes being the number of emergency transports and emergency department interventions, inpatient bed days, total deaths, and associated costs. Compared with TOR protocol use, current practice was projected to generate an additional 1,118 (95% uncertainty interval: 1,117–1,119) emergency transports and subsequent emergency treatments per 10,000 OHCA cases. It also resulted in 93 (95% UI: 66–120) excess inpatient bed days. However, universal transport was associated with 3 fewer deaths (95% UI: 2–4) per 10,000 patients, suggesting a small number of potentially avoidable prehospital deaths under the TOR protocol. Implementation of a Termination of Resuscitation protocol in Singapore could substantially reduce emergency transports, emergency interventions, hospital bed utilization, and overall healthcare expenditure for out-of-hospital cardiac arrest. Although the protocol may carry a small risk of premature termination in rare salvageable cases, the evidence supports its adoption as a means to improve resource allocation and minimize non-beneficial interventions.
