Abstract 256: Novel Universal Field Termination-of-Resuscitation Decision Rules for Predicting Nonsurvivors After Refractory Out-of-Hospital Cardiac Arrest
Introduction: Pre-hospital termination-of-resuscitation (TOR) decision rules have been introduced for emergency medical services personnel to identify non-survivors after refractory out-of-hospital cardiac arrest (OHCA) according to their life support care levels.
Hypothesis: We assessed the hypothesis that our newly developed universal TOR rules for mixed levels of providers can predict non-survivors with an appropriate positive predictive value (PPV).
Methods: We analyzed 495607 OHCA adult patients with all causes, using a prospectively recorded nationwide Utstein-style database in Japan over 5 years (2005-2009). Main outcome measures were specificity and PPV of newly developed TOR rules for predicting 1-month survival with unfavorable neurological outcome (cerebral performance category = 3-5). Secondary outcome measures were specificity and PPV of new rules for predicting 1-month death. We developed new TOR rules using data from 4 years (2005-2008, n = 390577), with validation using external data from 2009 (n = 105030).
Results: Multivariate logistic regression analysis showed that no return of spontaneous circulation had the strongest association with outcome (odds ratio [OR] 38.3; 95% confidence interval [CI] 35.9-41.0). Unshockable initial rhythm (OR 3.38; 95%CI 2.98-3.84) and witnessed by bystanders (OR 2.01; 95%CI 1.87-2.17) were also independently associated with neurological outcomes. Three variables were incorporated into new TOR rules. New rules showed 0.939 specificity (95%CI 0.933-0.945) and 0.998 PPV (95%CI 0.998-0.999) for identifying survivors with unfavorable outcome, and had a c-statistic of 0.922. The specificity, PPV, and c-statistic for external validation data were 0.966 (95%CI 0.958-0.973), 0.999 (95%CI 0.999-0.999), and 0.942, respectively. The specificity and PPV in developing group for predicting 1-month death were 0.875 (95%CI 0.870-0.881) and 0.992 (95%CI 0.991-0.992), respectively, and those in validation group were 0.903 (95%CI 0.894-0.911) and 0.993 (95%CI 0.992-0.993), respectively.
Conclusions: Novel developed universal field TOR decision rules for mixed levels of providers can predict non-survivors after refractory out-of-hospital cardiac arrest with appropriate PPV.
- © 2012 by American Heart Association, Inc.