A Simple Scoring System for Identifying Favorable Neurologic Outcomes Among Out-of-Hospital Cardiac Arrest Patients With Asystole - 26/07/24

Doi : 10.1016/j.annemergmed.2024.06.016

Hanna Park, MD, Sang-Min Kim, MD, Hyojeong Kwon, MD, Dongju Kim, MD, Youn-Jung Kim, MD, PhD, Won Young Kim, MD, PhD ^⁎
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

^∗Corresponding Author.

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Abstract

Study objective

Asystole is the most common initial rhythm in out-of-hospital cardiac arrest (OHCA) but indicates a low likelihood of neurologic recovery. This study aimed to develop a novel scoring system to be easily applied at the time of emergency department arrival for identifying favorable neurologic outcomes in OHCA survivors with an asystole rhythm.

Methods

This study is a secondary analysis based on a previously collected nationwide database, targeting nontraumatic adult OHCA patients aged ≥18 years with an asystole rhythm who achieved return of spontaneous circulation (ROSC) between January 2016 and December 2020. The primary outcome was a favorable neurologic outcome defined as Cerebral Performance Categories scores of 1 or 2 at hospital discharge. A prediction model was developed through multivariable logistic regression analysis in a derivation cohort in the form of a scoring system (WBC-ASystole). The performance and calibration of the model were tested using an internal validation cohort.

Results

Among 19,803 OHCA patients with survival to hospital admission, 6,322 had asystole, and 285 (4.5%) achieved good neurologic outcomes. Factors associated with favorable outcomes included age, witness arrest, bystander cardiopulmonary resuscitation, time from call to hospital arrival, and out-of-hospital ROSC achievement. The WBC-ASystole score, totaling 11 points, exhibited a predictive performance with an area under the receiver operating characteristic curve of 0.80 (95% confidence interval [CI] 0.76 to 0.83) and 0.79 (95% CI 0.74 to 0.83) in the derivation and validation cohorts, respectively. After categorizing patients into 3 groups based on probability for good neurologic outcomes, the sensitivity and specificity were as follows: 0.98 (95% CI 0.97 to 0.99) and 0.09 (95% CI 0.09 to 0.10) for the very low predicted probability group (WBC-ASystole ≤2), 0.85 (95% CI 0.82 to 0.89) and 0.54 (95% CI 0.53 to 0.55) for the low predicted probability group (WBC-ASystole 3 to 4), and 0.36 (95% CI 0.34 to 0.39) and 0.93 (95% CI 0.92 to 0.93) for fair predicted probability group (WBC-ASystole≥5), respectively.

Conclusions

Although external validation studies must be performed, among OHCA patients with asystole, the WBC-ASystole scoring system may identify those patients who are likely to have a favorable neurologic outcome.

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Plan

Introduction

Background

Methods

Study Design and Settings

Selection of Participants

	Supervising editor: Clifton Callaway, MD, PhD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: HP is first author and has drafted the manuscript. WYK and SMK had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. WYK designed and supervised the study. All authors contributed to acquisition, analysis, interpretation of data, and revised the manuscript for important intellectual content. All authors approved the final version and had final responsibility for the decision to submit for publication. The corresponding author attests that all listed authors meet authorship criteria and that no other meeting the criteria have been omitted. WYK takes responsibility for the paper as a whole.
	Data sharing statement: The authors conducted this study using raw data from the out-of-hospital cardiac arrest surveillance database distributed by the Korea Disease Control and Prevention Agency. The raw data includes all deidentified data files and a data dictionary. Researchers can access this information by submitting an application available at the following URL: injury. The authors analyzed the raw data by including only the data that met the inclusion criteria. The analytic code and subset of the raw data can be provided upon reasonable request from the date of article publication by contacting the corresponding author, Won Young Kim, at wonpia73@naver.com.
	Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). This study was conducted without financial support. The authors have no conflict of interest relevant to this article to disclose.
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