Nadolny Klaudiusz, Bujak Kamil, Obremska Marta, Zysko Dorota, Sterlinski Maciej, Szarpak Lukasz, Kubica Jacek, Ladny Jerzy Robert, Gasior Mariusz
Department of Emergency Medical Service, Higher School of Strategic Planning in Dabrowa Gornicza, Dabrowa Gornicza, Poland; Faculty of Medicine, Katowice School of Technology, Katowice, Poland.
3rd Department of Cardiology, Silesian Center for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Am J Emerg Med. 2021 Apr;42:90-94. doi: 10.1016/j.ajem.2021.01.018. Epub 2021 Jan 15.
The aim of the study was to assess the usefulness of the Glasgow Coma Scale (GCS) score assessed by EMS team in predicting survival to hospital discharge in patients after out-of-hospital cardiac arrest (OHCA).
Silesian Registry of OHCA (SIL-OHCA) is a prospective, population-based regional registry of OHCAs. All cases of OHCAs between the 1st of January 2018 and the 31st of December 2018 were included. Data were collected by EMS using a paper-based, Utstein-style form. OHCA patients aged ≥18 years, with CPR attempted or continued by EMS, who survived to hospital admission, were included in the current analysis. Patients who did not achieve return of spontaneous circulation (ROSC) in the field, with missing data on GCS after ROSC or survival status at discharge were excluded from the study.
Two hundred eighteen patients with OHCA, who achieved ROSC, were included in the present analysis. ROC analysis revealed GCS = 4 as a cut-off value in predicting survival to discharge (AUC 0.735; 95%CI 0.655-0.816; p < 0.001). Variables significantly associated with in-hospital survival were young age, short response time, witnessed event, previous myocardial infarction, chest pain before OHCA, initial shockable rhythm, coronary angiography, and GCS > 4. On the other hand, epinephrine administration, intubation, the need for dispatching two ambulances, and/or a physician-staffed ambulance were associated with a worse prognosis. Multivariable logistic regression analysis revealed GCS > 4 as an independent predictor of in-hospital survival after OHCA (OR of 6.4; 95% CI 2.0-20.3; p < 0.0001). Other independent predictors of survival were the lack of epinephrine administration, previous myocardial infarction, coronary angiography, and the patient's age.
The survival to hospital discharge after OHCA could be predicted by the GCS score on hospital admission.
本研究旨在评估急救医疗服务（EMS）团队评估的格拉斯哥昏迷量表（GCS）评分在预测院外心脏骤停（OHCA）患者出院生存率方面的有效性。
西里西亚OHCA登记处（SIL-OHCA）是一个基于人群的前瞻性区域OHCA登记处。纳入了2018年1月1日至2018年12月31日期间所有OHCA病例。急救人员使用纸质的Utstein式表格收集数据。年龄≥18岁、急救人员尝试或持续进行心肺复苏（CPR）且存活至入院的OHCA患者纳入本分析。未在现场实现自主循环恢复（ROSC）、ROSC后GCS数据缺失或出院时生存状态缺失的患者被排除在研究之外。
本分析纳入了218例实现ROSC的OHCA患者。ROC分析显示，GCS = 4是预测出院生存率的临界值（曲线下面积[AUC] 0.735；95%置信区间[CI] 0.655 - 0.816；p < 0.001）。与院内生存显著相关的变量包括年轻、反应时间短、事件有目击者、既往心肌梗死、OHCA前胸痛、初始可电击心律、冠状动脉造影以及GCS > 4。另一方面，肾上腺素给药、插管、需要派遣两辆救护车和/或配备医生的救护车与预后较差相关。多变量逻辑回归分析显示，GCS > 4是OHCA后院内生存的独立预测因素（比值比[OR]为6.4；95% CI 2.0 - 20.3；p < 0.0001）。其他生存的独立预测因素包括未使用肾上腺素、既往心肌梗死冠状动脉造影以及患者年龄。
OHCA后出院生存率可通过入院时的GCS评分进行预测。
