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.
Am J Emerg Med
; 71: 86-94, 2023 09.
Article
en En
| MEDLINE
| ID: mdl-37354894
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 ANDPARTICIPANTS:
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 ANDANALYSIS:
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. MAINRESULTS:
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.Palabras clave
Texto completo:
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Base de datos:
MEDLINE
Asunto principal:
Reanimación Cardiopulmonar
/
Servicios Médicos de Urgencia
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Paro Cardíaco Extrahospitalario
Tipo de estudio:
Diagnostic_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Humans
Idioma:
En
Revista:
Am J Emerg Med
Año:
2023
Tipo del documento:
Article
País de afiliación:
Taiwán