Termination of resuscitation in out-of-hospital cardiac arrest in women and men: An ESCAPE-NET project.

Autor: Smits RLA; Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands., Sødergren STF; Emergency Medical Services Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., van Schuppen H; Amsterdam UMC Location University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands., Folke F; Emergency Medical Services Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark., Ringh M; Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden., Jonsson M; Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden., Motazedi E; Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands., van Valkengoed IGM; Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands., Tan HL; Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands. Electronic address: h.l.tan@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2023 Apr; Vol. 185, pp. 109721. Date of Electronic Publication: 2023 Feb 13.
DOI: 10.1016/j.resuscitation.2023.109721
Abstrakt: Aim: Women have less favorable resuscitation characteristics than men. We investigated whether the Advanced Life Support Termination of Resuscitation rule (ALS-TOR) performs equally in women and men. Additionally, we studied whether adding or removing criteria from the ALS-TOR improved classification into survivors and non-survivors.
Methods: We analyzed 6,931 female and 14,548 male out-of-hospital cardiac arrest (OHCA) patients from Dutch and Swedish registries, and validated in 10,772 female and 21,808 male Danish OHCA patients. Performance measures were calculated for ALS-TOR in relation to 30-day survival. Recursive partitioning analysis was performed with the ALS-TOR criteria, as well as age, comorbidities, and additional resuscitation characteristics (e.g. initial rhythm, OHCA location). Finally, we explored if we could reduce the number of ALS-TOR criteria without loss of prognostic value.
Results: The ALS-TOR had a specificity and positive predictive value (PPV) of ≥99% in both women and men (e.g. PPV 99.9 in men). Classification by recursive partitioning analysis showed a high sensitivity but a PPV below 99%, thereby exceeding the acceptable miss rate of 1%. A combination of no return of spontaneous circulation (ROSC) before transport to the hospital and unwitnessed OHCA resulted in nearly equal specificity and PPV, higher sensitivity, and a lower transport rate to the hospital than the ALS-TOR.
Conclusion: For both women and men, the ALS-TOR has high specificity and low miss rate for predicting 30-day OHCA survival. We could not improve the classification with additional characteristics. Employing a simplified version may decrease the number of futile transports to the hospital.
Competing Interests: Conflicts of interest statement Shaun Theodor Flortentz Sødergren reports grants from the Danish foundation TrygFonden to his institution and Hans van Schuppen reports grants to his institution from the Zoll Foundation and Stryker Emergency Care.
(Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: