Abstract 135: Usefulness of Combination of Prehospital Termination of Resuscitation Clinical Prediction Rule and Cerebral Regional Saturation of Oxygen on Arrival for Predicting the Prognosis of Out-of-Hospital Cardiopulmonary Arrest Patients in Japan
Introduction: In Japan, almost all out-of-hospital cardiopulmonary arrest (OHCA) patients undergo resuscitation efforts and are transported to an emergency and critical care center. However, OHCA patients should be treated based on the prediction of their prognosis. “Prehospital termination of resuscitation (TOR) clinical prediction rule” and “Cerebral regional saturation of oxygen (rSO2) on arrival” are considered simple and noninvasive prognostic indicators.
Hypothesis: We assessed the hypothesis that the prognosis can be more accurately predicted in OHCA patients by combining the “prehospital TOR clinical prediction rule” and “cerebral rSO2 on arrival.”
Methods: This was a single-center prospective cohort study of OHCA patients transported to our hospital between October 2012 and March 2013. We examined the rate of return of spontaneous circulation (ROSC) and survival rate in patients who were classified based on whether the TOR rule was met during prehospital care and whether rSO2 was 25% or less on arrival at the hospital.
Results: Of 118 OHCA patients, 58 (49.2%) met the prehospital TOR rule. Of 45 patients who underwent cerebral rSO2 measurement on arrival at the hospital, 29 patients (64.4%) showed rSO2 ≤ 25%. For “no ROSC,” the positive predictive value (PPV) of prehospital TOR rule was 91.4%, and the PPV of cerebral rSO2 on arrival was 86.2%. For the OHCA patients who not only met the prehospital TOR rule but also showed rSO2 ≤ 25% on arrival, the PPV was 100%.
Conclusions: The “prehospital TOR rule” or “cerebral rSO2 on arrival” is not always useful when used separately. However, when combined, they can predict the prognosis with a high degree of accuracy. Although, further studies are required to predict the survival rate and neurologic prognosis, by using these 2 steps, it is possible to identify a patient who would not respond to treatment without achieving ROSC.
- © 2013 by American Heart Association, Inc.