Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Department of Emergency Medicine, Thammasat University Hospital, Pathum Thani Province, Thailand.
Int J Clin Pract. 2020 Jul;74(7):e13502. doi: 10.1111/ijcp.13502. Epub 2020 Apr 7.
Out-of-hospital cardiac arrest is an emergency that requires immediate management to save lives. However, some predictive scores for the immediate outcomes of patients with out-of-hospital cardiac arrest are difficult to use in clinical practice.
This study aimed to identify predictors of sustained return of spontaneous circulation and to develop a predictive score.
This prospective observational study evaluated sustained return of spontaneous circulation among out-of-hospital cardiac arrest patients in a Thai emergency department between July 2014 and March 2018. The baseline characteristics and prehospital and hospital findings were analysed.
Of 347 patients, 126 (36.3%) had sustained return of spontaneous circulation and 20 (5.8%) were discharged. Witnessed arrest (odds ratio = 2.9, 95% confidence interval 1.3-6.2), time from arrest to chest compression <15 min (odds ratio = 3.0, 95% confidence interval 1.3-7.0) and chest compression duration <30 min (odds ratio = 15.6, 95% confidence interval 8.7-28.0) predicted sustained return of spontaneous circulation; these were developed into the WATCH-CPR (Witnessed Arrest, Time from arrest to CHest compression-CPR duration) score. A score of ≥2 was optimal for predicting sustained return of spontaneous circulation, which provided an area under the receiver operating characteristic of 0.775 (95% confidence interval 0.724-0.825) and a sensitivity of 72.2% (95% confidence interval 63.4-79.6%) and specificity of 76.0% (95% confidence interval 69.8-81.4%).
The factors including witnessed arrest, time from arrest to chest compression and chest compression duration were developed as the WATCH-CPR score for predicting sustained return of spontaneous circulation among patients with out-of-hospital cardiac arrest.
院外心脏骤停是一种紧急情况，需要立即进行管理以挽救生命。然而，一些用于预测院外心脏骤停患者即时预后的预测评分在临床实践中难以使用。
本研究旨在确定可预测院外心脏骤停患者自主循环持续恢复的预测因素，并制定预测评分。
本前瞻性观察性研究评估了 2014 年 7 月至 2018 年 3 月期间泰国急诊科院外心脏骤停患者的自主循环持续恢复情况。分析了基线特征以及院前和院内发现。
在 347 名患者中，有 126 名（36.3%）自主循环持续恢复，有 20 名（5.8%）出院。目击者见证的心脏骤停（优势比=2.9，95%置信区间 1.3-6.2）、从心脏骤停到开始胸外按压的时间<15 分钟（优势比=3.0，95%置信区间 1.3-7.0）和胸外按压持续时间<30 分钟（优势比=15.6，95%置信区间 8.7-28.0）预测自主循环持续恢复；这些因素被纳入到 WATCH-CPR（目击者见证、从心脏骤停到开始胸外按压的时间-胸外按压持续时间）评分中。评分≥2 是预测自主循环持续恢复的最佳选择，其提供的受试者工作特征曲线下面积为 0.775（95%置信区间 0.724-0.825），敏感性为 72.2%（95%置信区间 63.4-79.6%），特异性为 76.0%（95%置信区间 69.8-81.4%）。
目击者见证、从心脏骤停到开始胸外按压的时间和胸外按压持续时间等因素被纳入到 WATCH-CPR 评分中，用于预测院外心脏骤停患者自主循环的持续恢复。
