Süzer Neslihan Ergün, Umaç Gülbin Aydoğdu, Alpar Süleyman, Yılmaz Sarper
Department of Emergency Medicine, Kocaeli Darıca Farabi Training and Research Hospital, Kocaeli, Turkey.
Department of Emergency Medicine, İzmir City Hospital, Izmir, Turkey.
BMC Emerg Med. 2025 Jul 1;25(1):107. doi: 10.1186/s12873-025-01265-1.
Cardiac arrest during ambulance transport is a complex situation that has features of both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) but lacks a clear classification. This study aimed to evaluate the diagnostic performance of prehospital and in-hospital ROSC prediction tools in patients experiencing cardiac arrest during ambulance transport.
A retrospective study was conducted with patients experiencing cardiac arrest during transport. Demographic, clinical, and treatment data were collected, including pre-arrest consciousness, arrest rhythm, and cardiopulmonary resuscitation duration. Four ROSC prediction scores (Prehospital-ROSC, the ROSC after cardiac arrest, Utstein-Based ROSC, and The Cardiac Arrest Survival Post-Resuscitation In-Hospital scores) were used to assess the patients. The AUROCs of the scores were compared to evaluate their diagnostic accuracy.
Patients were categorized into two groups based on ROSC: No-ROSC (n = 248, 75.2%) and ROSC (n = 82, 24.8%). The ROSC group had significantly more shockable rhythms (81.7% vs. 22.2%, p < 0.001) and a higher proportion of cardiac etiology (p = 0.015) compared to the No-ROSC group. The time for the ambulance to reach the patient did not significantly differ between groups (p = 0.140), but the time spent in the ambulance before arrest was significantly shorter in the ROSC group (p = 0.026). The prehospital-ROSC score had the highest diagnostic performance (AUROC 0.791), followed by The ROSC after cardiac arrest score (0.754) and The Utstein-Based ROSC score (0.716). The Cardiac Arrest Survival Post-Resuscitation In-Hospital score had the lowest performance (0.658). Prehospital-ROSC score outperformed the Utstein-Based ROSC score (p = 0.005), and the Cardiac Arrest Survival Post-Resuscitation In-Hospital score was significantly lower than both ROSC after cardiac arrest score (p = 0.031) and the prehospital-ROSC score (p < 0.001).
Prehospital-ROSC score was the most accurate predictor of ROSC in patients experiencing cardiac arrest during ambulance transport, while the Cardiac Arrest Survival Post-Resuscitation In-Hospital score demonstrated lower predictive accuracy.
救护车转运期间的心搏骤停是一种复杂情况，兼具院内心搏骤停（IHCA）和院外心搏骤停（OHCA）的特征，但缺乏明确分类。本研究旨在评估院前和院内恢复自主循环（ROSC）预测工具对救护车转运期间心搏骤停患者的诊断性能。
对转运期间心搏骤停的患者进行回顾性研究。收集人口统计学、临床和治疗数据，包括心搏骤停前意识、心搏骤停节律和心肺复苏持续时间。使用四种ROSC预测评分（院前ROSC、心搏骤停后ROSC、基于乌斯坦定义的ROSC和复苏后院内心搏骤停生存评分）对患者进行评估。比较各评分的曲线下面积（AUROC）以评估其诊断准确性。
根据ROSC将患者分为两组：未恢复自主循环组（n = 248，75.2%）和恢复自主循环组（n = 82，24.8%）。与未恢复自主循环组相比，恢复自主循环组有更多可电击心律（81.7%对22.2%，p < 0.001），且心脏病因比例更高（p = 0.015）。两组间救护车到达患者的时间无显著差异（p = 0.140），但恢复自主循环组在心搏骤停前在救护车上花费的时间显著更短（p = 0.026）。院前ROSC评分具有最高的诊断性能（AUROC 0.791），其次是心搏骤停后ROSC评分（0.754）和基于乌斯坦定义的ROSC评分（0.716）。复苏后院内心搏骤停生存评分的性能最低（0.658）。院前ROSC评分优于基于乌斯坦定义的ROSC评分（p = 0.005），且复苏后院内心搏骤停生存评分显著低于心搏骤停后ROSC评分（p = 0.031）和院前ROSC评分（p < 0.001）。
院前ROSC评分是救护车转运期间心搏骤停患者ROSC的最准确预测指标，而复苏后院内心搏骤停生存评分的预测准确性较低。
