验证心脏骤停后自主循环恢复（RACA）评分在两个不同国家/地区的有效性。
Validation of the return of spontaneous circulation after cardiac arrest (RACA) score in two different national territories.
机构信息
Department of Molecular Medicine, University of Pavia, Coronary Care Unit and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiocentro Ticino, Lugano, Switzerland.
Department of Molecular Medicine, University of Pavia, Coronary Care Unit and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
出版信息
Resuscitation. 2019 Jan;134:62-68. doi: 10.1016/j.resuscitation.2018.11.012. Epub 2018 Nov 14.
BACKGROUND
The likelihood of return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) is influenced by unmodifiable (gender, aetiology, location, the presence of witnesses and initial rhythm) and modifiable factors (bystander CPR and the time to EMS arrival). All of these have been included in the ROSC After Cardiac Arrest (RACA) score.
PURPOSE
To test the ability of the RACA score to predict the probability of ROSC in two different regions with different local resuscitation networks: the Swiss Canton Ticino and the Italian Province of Pavia.
METHODS AND RESULTS
All OHCAs occurred between January 1 2015 and December 31 2017 were included. The original regression coefficients for all RACA score variables were applied. The probability to obtain the ROSC as measured with the RACA score was divided in tertiles. Overall, 2041 OHCAs were included in the analysis. The RACA score showed good discrimination for ROSC (AUC 0.76) and calibration, without interaction (p 0.28) between the region and the probability of ROSC. The probability of ROSC was 15% for RACA scores <0.28, 20% for RACA scores between 0.28 and 0.42, increasing to 55% for RACA scores >0.42.
CONCLUSIONS
The application of the RACA score reliably assess the probability to obtain the ROSC, with equal effectiveness in the two regions, despite different organization of the resuscitation network. Patients with a RACA score >0.42 had more than 50% probability to obtain ROSC.
背景
院外心脏骤停（OHCA）后自主循环恢复（ROSC）的可能性受不可改变因素（性别、病因、地点、目击者的存在和初始节律）和可改变因素（旁观者心肺复苏和 EMS 到达时间）的影响。所有这些因素都已包含在 ROSC 后心脏骤停（RACA）评分中。
目的
在两个具有不同当地复苏网络的不同地区（瑞士提契诺州和意大利帕维亚省）测试 RACA 评分预测 ROSC 概率的能力。
方法和结果
纳入 2015 年 1 月 1 日至 2017 年 12 月 31 日期间发生的所有 OHCA。应用了所有 RACA 评分变量的原始回归系数。用 RACA 评分测量获得 ROSC 的概率分为三分位数。总体而言，纳入了 2041 例 OHCA 进行分析。RACA 评分对 ROSC 具有良好的区分度（AUC 0.76）和校准度，且在区域与 ROSC 概率之间无交互作用（p 0.28）。RACA 评分<0.28 的 ROSC 概率为 15%，RACA 评分在 0.28 至 0.42 之间的 ROSC 概率为 20%，RACA 评分>0.42 的 ROSC 概率增加至 55%。
结论
RACA 评分的应用能够可靠地评估获得 ROSC 的概率，在两个地区均具有相同的效果，尽管复苏网络的组织不同。RACA 评分>0.42 的患者获得 ROSC 的概率超过 50%。
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