Point-of-care testing for adult out-of-hospital cardiac arrest resuscitated at the ED to predict ROSC: Development and external validation of POC-ED-ROSC model - 03/08/23
, Chu-Lin Tsai, MD, ScD b, c , Cheng-Yi Wu, MD b, Eric Chou, MD d, e, Chih-Hung Wang, MD, PhD b, c, ⁎ , Min-Shan Tsai, MD, PhD b, c, Wei-Tien Chang, MD, PhD b, c , Chien-Hua Huang, MD, PhD b, c , Wen-Jone Chen, MD, PhD b, c, f Abstract |
Background and importance |
Most prediction models, like return of spontaneous circulation (ROSC) after cardiac arrest (RACA) or Utstein-based (UB)-ROSC score, were developed for prehospital settings to predict the probability of ROSC in patients with out-of-hospital cardiac arrest (OHCA). A prediction model has been lacking for the probability of ROSC in patients with OHCA at emergency departments (EDs).
Objective |
In the present study, a point-of-care (POC) testing-based model, POC-ED-ROSC, was developed and validated for predicting ROSC of OHCA at EDs.
Design, settings and participants |
Prospectively collected data for adult OHCA patients between 2015 and 2020 were analysed. POC blood gas analysis obtained within 5 min of ED arrival was used.
Outcomes measure and analysis |
The primary outcome was ROSC. In the derivation cohort, multivariable logistic regression was used to develop the POC-ED-ROSC model. In the temporally split validation cohort, the discriminative performance of the POC-ED-ROSC model was assessed using the area under the receiver operating characteristic (ROC) curve (AUC) and compared with RACA or UB-ROSC score using DeLong test.
Main results |
The study included 606 and 270 patients in the derivation and validation cohorts, respectively. In the total cohort, 471 patients achieved ROSC. Age, initial cardiac rhythm at ED, pre-hospital resuscitation duration, and POC testing-measured blood levels of lactate, potassium and glucose were significant predictors included in the POC-ED-ROSC model. The model was validated with fair discriminative performance (AUC: 0.75, 95% confidence interval [CI]: 0.69–0.81) with no significant differences from RACA (AUC: 0.68, 95% CI: 0.62–0.74) or UB-ROSC score (AUC: 0.74, 95% CI: 0.68–0.79).
Conclusion |
Using only six easily accessible variables, the POC-ED-ROSC model can predict ROSC for OHCA resuscitated at ED with fair accuracy.
Le texte complet de cet article est disponible en PDF.Keywords : Blood gas analysis, Emergency department, Out-of-hospital cardiac arrest, Point-of-care testing, Prediction model
Abbreviations : AUC, CPR, EMS, GAM, MI, NTUH, OHCA, PAROS, POC, ROC, ROSC
Plan
| ☆ | The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. |
Vol 71
P. 86-94 - septembre 2023 Retour au numéro
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