Ho Yi-Ju, Su Pei-I, Chi Chien-Yu, Tsai Min-Shan, Chen Yih-Sharng, Huang Chien-Hua
National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan.
National Taiwan University Hospital Yun-Lin Branch, Department of Emergency Medicine, Yun-Lin, Taiwan.
West J Emerg Med. 2024 Nov;25(6):894-902. doi: 10.5811/westjem.18601.
Extracorporeal cardiopulmonary resuscitation (ECPR) improves the prognosis of in-hospital cardiac arrest (IHCA). The six-factor RESCUE-IHCA score (resuscitation using ECPR during IHCA) was developed to predict outcomes of post-IHCA ECPR-treated adult patients. Our goal was to validate the score in an Asian medical center with a high volume and experience of ECPR performance and to compare the differences in patient characteristics between the current study and the original cohort in a 2022 observational study.
For this single-center, retrospective cohort study we enrolled 324 ECPR-treated adult IHCA patients. The primary outcome was in-hospital mortality. We used the area under the receiver operating curve (AUROC) to externally validate the RESCUE-IHCA score. The calibration of the model was tested by the decile calibration plot as well as Hosmer-Lemeshow goodness-of-fit with an associated -value.
Of the 324 participants, 231 (71%) died before hospital discharge. The discriminative performance of the RESCUE-IHCA score was comparable with the originally validated cohort, with an AUC of 0.63. A prolonged duration of cardiac arrest was associated with an increased risk of mortality (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.03, = .006). An initial rhythm of ventricular tachycardia (OR 0.14, 95% CI 0.04-0.51, = .003), ventricular fibrillation (OR 0.11, 95% CI 0.03-0.46, = .003), and palpable pulse (OR 0.26, 95% CI 0.07-0.92, = 0.04) were associated with a reduced mortality risk compared to asystole or pulseless electrical activity. In contrast to the original study, age ( = 0.28), resuscitation timing ( = 0.14), disease category ( = 0.18), and pre-existing renal insufficiency ( = 0.12) were not associated with in-hospital death.
In external validation, the RESCUE-IHCA score exhibited performance comparable to its original validation within the single-center population. Further investigation on hospital experience, time-of-day effect, and specific disease categories is warranted to improve the selection criteria for ECPR candidates during IHCA.
体外心肺复苏（ECPR）可改善院内心脏骤停（IHCA）的预后。六因素RESCUE - IHCA评分（用于预测IHCA期间使用ECPR进行复苏的情况）旨在预测接受IHCA后ECPR治疗的成年患者的预后。我们的目标是在一家具有高容量ECPR实施经验的亚洲医疗中心验证该评分，并在一项2022年的观察性研究中比较本研究与原始队列患者特征的差异。
在这项单中心回顾性队列研究中，我们纳入了324例接受ECPR治疗的成年IHCA患者。主要结局是院内死亡率。我们使用受试者工作特征曲线下面积（AUROC）对RESCUE - IHCA评分进行外部验证。通过十分位数校准图以及Hosmer - Lemeshow拟合优度检验及相关P值来测试模型的校准情况。
在324名参与者中，231例（71%）在出院前死亡。RESCUE - IHCA评分的判别性能与最初验证的队列相当，AUC为0.63。心脏骤停持续时间延长与死亡风险增加相关（比值比[OR]1.02，95%置信区间[CI]1.01 - 1.03，P = 0.006）。与心脏停搏或无脉电活动相比，初始心律为室性心动过速（OR 0.14，95% CI 0.04 - 0.51，P = 0.003）、心室颤动（OR 0.11，95% CI 0.03 - 0.46，P = 0.003）和可触及脉搏（OR 0.26，95% CI 0.07 - 0.92，P = 0.04）与死亡风险降低相关。与原始研究不同，年龄（P = 0.28）、复苏时机（P = 0.14）、疾病类别（P = 0.18）和既往肾功能不全（P = 0.12）与院内死亡无关。
在外部验证中，RESCUE - IHCA评分在单中心人群中的表现与其原始验证相当。有必要进一步研究医院经验、一天中的时间效应和特定疾病类别，以改进IHCA期间ECPR候选者的选择标准。
