Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan.
PLoS One. 2022 Aug 10;17(8):e0270986. doi: 10.1371/journal.pone.0270986. eCollection 2022.
Termination-of-resuscitation rules (TORRs) in out-of-hospital cardiac arrest (OHCA) patients have been applied in western countries; in Asia, two TORRs were developed and have not been externally validated widely. We aimed to externally validate the TORRs using the registry of Pan-Asian Resuscitation Outcomes Study (PAROS).
PAROS enrolled 66,780 OHCA patients in seven Asian countries from 1 January 2009 to 31 December 2012. The American Heart Association-Basic Life Support and AHA-ALS (AHA-BLS), AHA-Advanced Life Support (AHA-ALS), Goto, and Shibahashi TORRs were selected. The diagnostic test characteristics and area under the receiver operating characteristic curve (AUC) were calculated. We further determined the most suitable TORR in Asia and analysed the variable differences between subgroups.
We included 55,064 patients in the final analysis. The sensitivity, specificity, negative predictive value, positive predictive value, and AUC, respectively, for AHA-BLS, AHA-ALS, Goto, Shibashi TORRs were 79.0%, 80.0%, 19.6%, 98.5%, and 0.80; 48.6%, 88.3%, 9.8%, 98.5%, and 0.60; 53.8%, 91.4%, 11.2%, 99.0%, and 0.73; and 35.0%, 94.2%, 8.4%, 99.0%, and 0.65. In countries using the Goto TORR with PPV<99%, OHCA patients were younger, had more males, a higher rate of shockable rhythm, witnessed collapse, pre-hospital defibrillation, and survival to discharge, compared with countries using the Goto TORR with PPV ≥99%.
There was no single TORR fit for all Asian countries. The Goto TORR can be considered the most suitable; however, a high predictive performance with PPV ≥99% was not achieved in three countries using it (Korea, Malaysia, and Taiwan).
在院外心脏骤停（OHCA）患者中，已经应用了复苏终止规则（TORR），但在亚洲，制定了两种 TORR 且尚未广泛进行外部验证。我们旨在使用泛亚洲复苏结果研究（PAROS）的登记处来验证 TORR。
PAROS 纳入了 2009 年 1 月 1 日至 2012 年 12 月 31 日来自七个亚洲国家的 66780 例 OHCA 患者。选择了美国心脏协会基础生命支持和 AHA-ALS（AHA-BLS）、AHA-高级生命支持（AHA-ALS）、后藤和柴桥 TORR。计算了诊断测试的特征和受试者工作特征曲线下的面积（AUC）。我们进一步确定了亚洲最适合的 TORR，并分析了亚组之间的变量差异。
我们最终分析纳入了 55064 例患者。AHA-BLS、AHA-ALS、后藤、柴桥 TORR 的敏感性、特异性、阴性预测值、阳性预测值和 AUC 分别为 79.0%、80.0%、19.6%、98.5%和 0.80；48.6%、88.3%、9.8%、98.5%和 0.60；53.8%、91.4%、11.2%、99.0%和 0.73；和 35.0%、94.2%、8.4%、99.0%和 0.65。在使用阳性预测值<99%的后藤 TORR 的国家中，OHCA 患者更年轻，男性更多，可除颤节律的发生率更高，目击倒地，院前除颤和出院存活率更高。
没有一种 TORR 适合所有亚洲国家。后藤 TORR 可以被认为是最合适的，但在使用该 TORR 的三个国家（韩国、马来西亚和中国台湾），并未达到阳性预测值≥99%的高预测性能。
