National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan.
National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan.
West J Emerg Med. 2023 Apr 4;24(3):605-614. doi: 10.5811/westjem.59005.
The return of spontaneous circulation after cardiac arrest (RACA) score is a well-validated model for estimating the probability of return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA) by incorporating several variables, including gender, age, arrest aetiology, witness status, arrest location, initial cardiac rhythms, bystander cardiopulmonary resuscitation (CPR), and emergency medical services (EMS) arrival time. The RACA score was initially designed for comparisons between different EMS systems by standardising ROSC rates. End-tidal carbon dioxide (EtCO) is a quality indicator of CPR. We aimed to improve the performance of the RACA score by adding minimum EtCO measured during CPR to develop the EtCO + RACA score for OHCA patients transported to an emergency department (ED).
This was a retrospective analysis using prospectively collected data for OHCA patients resuscitated at an ED during 2015-2020. Adult patients with advanced airways inserted and available EtCO measurements were included. We used the EtCO values recorded in the ED for analysis. The primary outcome was ROSC. In the derivation cohort, we used multivariable logistic regression to develop the model. In the temporally split validation cohort, we assessed the discriminative performance of the EtCO + RACA score by the area under the receiver operating characteristic curve (AUC) and compared it with the RACA score using the DeLong test.
There were 530 and 228 patients in the derivation and validation cohorts, respectively. The median measurements of EtCO were 8.0 times (interquartile range [IQR] 3.0-12.0 times), with the median minimum EtCO of 15.5 millimeters of mercury (mm Hg) (IQR 8.0-26.0 mm Hg). The median RACA score was 36.4% (IQR 28.9-48.0%), and a total of 393 patients (51.8%) achieved ROSC. The EtCO + RACA score was validated with good discriminative performance (AUC, 0.82, 95% CI 0.77-0.88), outperforming the RACA score (AUC, 0.71, 95% CI 0.65-0.78) (DeLong test: P < 0.001).
The EtCO + RACA score may facilitate the decision-making process regarding allocations of medical resources in EDs for OHCA resuscitation.
心脏骤停后自主循环恢复（ROSC）评分是一种经过充分验证的模型，可通过纳入多项变量（包括性别、年龄、骤停病因、目击者状态、骤停位置、初始心搏节律、旁观者心肺复苏（CPR）和急救医疗服务（EMS）到达时间）来估计院外心脏骤停（OHCA）患者自主循环恢复（ROSC）的概率。ROSC 评分最初是为了通过标准化 ROSC 率来比较不同的 EMS 系统而设计的。呼气末二氧化碳（EtCO）是 CPR 的质量指标。我们旨在通过添加在 CPR 期间测量的最小 EtCO 来提高 ROSC 评分的性能，从而为转运至急诊科（ED）的 OHCA 患者开发 EtCO+ROSC 评分。
这是一项回顾性分析，使用 2015 年至 2020 年在 ED 复苏的 OHCA 患者前瞻性收集的数据。纳入了插入高级气道且有可用 EtCO 测量值的成年患者。我们使用在 ED 记录的 EtCO 值进行分析。主要结局是 ROSC。在推导队列中，我们使用多变量逻辑回归来建立模型。在时间分割验证队列中，我们通过接受者操作特征曲线下的面积（AUC）评估 EtCO+ROSC 评分的判别性能，并使用 DeLong 检验将其与 ROSC 评分进行比较。
推导队列和验证队列分别有 530 例和 228 例患者。EtCO 的中位测量值为 8.0 倍（四分位距[IQR]3.0-12.0 倍），最小 EtCO 的中位数为 15.5 毫米汞柱（mmHg）（IQR 8.0-26.0 mmHg）。ROSC 评分的中位数为 36.4%（IQR 28.9-48.0%），共有 393 例患者（51.8%）实现了 ROSC。EtCO+ROSC 评分具有良好的判别性能（AUC 为 0.82，95%CI 为 0.77-0.88），优于 ROSC 评分（AUC 为 0.71，95%CI 为 0.65-0.78）（DeLong 检验：P<0.001）。
EtCO+ROSC 评分可能有助于决策在 ED 进行 OHCA 复苏时分配医疗资源。
