Termkijwanich Phatcha, Sanguanwit Pitsucha, Yuksen Chaiyaporn, Trakulsrichai Satariya, Sricharoen Pungkava
Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Arch Acad Emerg Med. 2025 Jun 28;13(1):e59. doi: 10.22037/aaemj.v13i1.2656. eCollection 2025.
Termination of resuscitation (TOR) rules in out of hospital cardiac arrest (OHCA) varies across different healthcare settings and populations. This study aimed to externally validate ten TOR rules for predicting death before hospital admission among OHCA patients.
A retrospective prognostic accuracy study analyzed 379 non-trauma OHCA patients (≥18 years) in Bangkok who were either treated by the emergency medical services (EMS) of Ramathibodi Hospital or transported to Ramathibodi's emergency department by another EMS provider (January 2010 - March 2023). The predictive performance of ten TOR rules (AHA-BLS, AHA-ALS, Korean Cardiac Arrest Research Consortium (KoCARC) rules I, II, and III, Goto's rule, Shihabashi's rule, the New Model I, Helsinki's, and Petrie's rule) in predicting death before hospital admission as well as false positive rates (FPRs) of rules at various resuscitation times were calculated and reported with 95% confidence interval (CI).
Among 379 OHCA patients, 308 (81.27%) died before hospital admission and 71 (18.73%) survived to discharge. The New model I demonstrated the most conservative predictive performance with sensitivity of 96.7% (95% CI: 93.0-98.8), NPV of 91.5% (95% CI: 82.5-96.8), and area under the curve (AUC) of 0.74 (95% CI: 0.70-0.79). The KoCARC III showed FPR of 2.8%. Based on the initial presenting criteria, the FPR varied at different resuscitation time points, with increasing FPR over 30 minutes. Among all rules, Helsinki's and AHA-BLS showed the highest FPRs (1.14 - 21.13 and 1.14 - 23.94, respectively) while the KoCARC TOR rules III demonstrated the most conservative consistency in maintaining a low FPR (0-2.82%) throughout time.
The KoCARC III demonstrated relatively high safety for TOR decisions in Bangkok's OHCA population, with the lowest FPR, and high sensitivity and NPV. TOR rules showed higher FPRs compared to previous studies. These findings should be interpreted with caution due to the retrospective design, potential selection bias, and EMS protocol changes over the 10-year study period.
院外心脏骤停（OHCA）的复苏终止（TOR）规则在不同的医疗环境和人群中存在差异。本研究旨在对十条预测OHCA患者入院前死亡的TOR规则进行外部验证。
一项回顾性预后准确性研究分析了曼谷379例非创伤性OHCA患者（≥18岁），这些患者要么由拉玛蒂博迪医院的紧急医疗服务（EMS）进行治疗，要么由另一家EMS供应商转运至拉玛蒂博迪医院急诊科（2010年1月至2023年3月）。计算并报告了十条TOR规则（美国心脏协会基础生命支持（AHA-BLS）、美国心脏协会高级生命支持（AHA-ALS）、韩国心脏骤停研究联盟（KoCARC）规则I、II和III、后藤规则、柴桥规则、新模型I、赫尔辛基规则和皮特里规则）预测入院前死亡的性能以及各复苏时间点规则的假阳性率（FPR），并给出95%置信区间（CI）。
在379例OHCA患者中，308例（81.27%）入院前死亡，71例（18.73%）存活至出院。新模型I表现出最保守的预测性能，灵敏度为96.7%（95%CI：93.0 - 98.8），阴性预测值为91.5%（95%CI：82.5 - 96.8），曲线下面积（AUC）为0.74（95%CI：0.70 - 0.79）。KoCARC III的FPR为2.8%。根据初始呈现标准，FPR在不同的复苏时间点有所不同，超过30分钟时FPR增加。在所有规则中，赫尔辛基规则和AHA-BLS的FPR最高（分别为1.14 - 21.13和1.14 - 23.94），而KoCARC TOR规则III在整个时间段内保持低FPR（0 - 2.82%）方面表现出最保守的一致性。
KoCARC III在曼谷的OHCA人群中显示出相对较高的TOR决策安全性，FPR最低，灵敏度和阴性预测值较高。与先前研究相比，TOR规则显示出更高的FPR。由于本研究为回顾性设计、存在潜在选择偏倚以及在10年研究期间EMS协议发生变化，这些结果应谨慎解读。
