External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era
| Autor: | Haewon Jung, Mi Jin Lee, Jae Wan Cho, Sang Hun Lee, Suk Hee Lee, You Ho Mun, Han-sol Chung, Yang Hun Kim, Gyun Moo Kim, Sin-youl Park, Jae Cheon Jeon, Changho Kim, on behalf of the WinCOVID-19 consortium |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
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medicine.medical_specialty Resuscitation Emergency Medical Services medicine.medical_treatment Return of spontaneous circulation Critical Care and Intensive Care Medicine Decision Support Techniques Predictive Value of Tests Republic of Korea Emergency medical services medicine Humans Cardiopulmonary resuscitation Registries Asystole Original Research Aged Resuscitation Orders Ethics Aged 80 and over business.industry lcsh:Medical emergencies. Critical care. Intensive care. First aid Basic life support COVID-19 lcsh:RC86-88.9 Heart arrest Middle Aged medicine.disease Prognosis Advanced life support Coronavirus disease Predictive value of tests Emergency medicine Emergency Medicine Female business Medical Futility Out-of-Hospital Cardiac Arrest |
| Zdroj: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 29, Iss 1, Pp 1-10 (2021) |
| ISSN: | 1757-7241 |
| Popis: | Background Futile resuscitation for out-of-hospital cardiac arrest (OHCA) patients in the coronavirus disease (COVID)-19 era can lead to risk of disease transmission and unnecessary transport. Various existing basic or advanced life support (BLS or ALS, respectively) rules for the termination of resuscitation (TOR) have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era. Methods This was a multicenter observational study using the WinCOVID-19 Daegu registry data collected during February 18–March 31, 2020. The subjects were patients who showed cardiac arrest of presumed cardiac etiology. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity, specificity, false positive value (FPV), and positive predictive value (PPV) of each TOR rule were evaluated. Results In total, 170 of the 184 OHCA patients were eligible and evaluated. TOR was recommended for 122 patients based on the international basic life support termination of resuscitation (BLS-TOR) rule, which showed 85% specificity, 74% sensitivity, 0.8% FPV, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPV (upper limit of 95% confidence interval 99%) criteria, only the KoCARC TOR rule I, which included a combination of three factors including not being witnessed by emergency medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock delivery or return of spontaneous circulation, was found to be superior to all other TOR rules. Conclusion Among the previous nine BLS and ALS TOR rules, KoCARC TOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide. |
| Databáze: | OpenAIRE |
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