Department of Emergency Medicine, Dong-A University College of Medicine, Dong-A University Hospital, Busan, 49201, South Korea.
Department of Emergency Medicine, Seoul Medical Center, Seoul, 02053, South Korea.
Sci Rep. 2023 Jan 25;13(1):1403. doi: 10.1038/s41598-023-28789-5.
This study aimed to validate the predictive performance of the termination of resuscitation (TOR) rule and examine the compression time interval (CTI) as a criterion for modifying the rule. This retrospective observational study analyzed adult out-of-hospital cardiac arrest (OHCA) patients attended by emergency medical service (EMS) providers in mixed urban-rural areas in Korea in 2020 and 2021. We evaluated the predictive performance of basic life support (BLS) and the Korean Cardiac Arrest Research Consortium (KoCARC) TOR rule using the false-positive rate (FPR) and positive predictive value (PPV). We modified the age cutoff criterion and examined the CTI as a new criterion. According to the TOR rule, 1827 OHCA patients were classified into two groups. The predictive performance of the BLS TOR rule had an FPR of 11.7% (95% confidence interval (CI): 5.9-17.5) and PPV of 98.4% (97.6-99.2) for mortality, and an FPR of 3.6% (0.0-7.8) and PPV of 78.6% (75.9-81.3) for poor neurological outcomes at hospital discharge. The predictive performance of the KoCARC TOR rule had an FPR of 5.0% (1.1-8.9) and PPV of 98.9% (98.0-99.8) for mortality, and an FPR of 3.7% (0.0-7.8) and PPV of 50.0% (45.7-54.3) for poor neurological outcomes at hospital discharge. The modified cutoff value for age was 68 years, with an area under the receiver operating characteristic curve over 0.7. In the group that met the BLS TOR rule, the cutoff of the CTI for death was not determined and was 21 min for poor neurological outcomes. In the group that met the KoCARC TOR rule, the cutoff of the CTI for death and poor neurological outcomes at the time of hospital discharge was 25 min and 21 min, respectively. The BLS TOR and KoCARC TOR rules showed inappropriate predictive performance for mortality and poor neurological outcomes. However, the predictive performance of the TOR rule could be supplemented by modifying the age criterion and adding the CTI criterion of the KoCARC.
本研究旨在验证复苏终止（TOR）规则的预测性能，并探讨压缩时间间隔（CTI）作为修改该规则的标准。这是一项回顾性观察研究，分析了 2020 年和 2021 年在韩国城乡混合地区由急救医疗服务（EMS）提供者救治的成年院外心脏骤停（OHCA）患者。我们使用假阳性率（FPR）和阳性预测值（PPV）评估基本生命支持（BLS）和韩国心脏骤停研究联盟（KoCARC）TOR 规则的预测性能。我们修改了年龄截断标准，并将 CTI 作为新的标准进行了检验。根据 TOR 规则，1827 例 OHCA 患者被分为两组。BLS TOR 规则的预测性能对死亡率的 FPR 为 11.7%（95%置信区间（CI）：5.9-17.5）和 PPV 为 98.4%（97.6-99.2），对出院时不良神经结局的 FPR 为 3.6%（0.0-7.8）和 PPV 为 78.6%（75.9-81.3）。KoCARC TOR 规则的预测性能对死亡率的 FPR 为 5.0%（1.1-8.9）和 PPV 为 98.9%（98.0-99.8），对出院时不良神经结局的 FPR 为 3.7%（0.0-7.8）和 PPV 为 50.0%（45.7-54.3）。年龄的修正截断值为 68 岁，受试者工作特征曲线下面积超过 0.7。在符合 BLS TOR 规则的组中，死亡的 CTI 截断值尚未确定，为 21 分钟，神经结局不良。在符合 KoCARC TOR 规则的组中，死亡和出院时神经功能不良的 CTI 截断值分别为 25 分钟和 21 分钟。BLS TOR 和 KoCARC TOR 规则对死亡率和不良神经结局的预测性能均不理想。然而，通过修改年龄标准并添加 KoCARC 的 CTI 标准，可以补充 TOR 规则的预测性能。
