Abstract 259: Available Prehospital Covariates Predict Coronary Ischemia as the Cause of Sudden Out-of-Hospital Cardiac Arrest Among Failed Resuscitations
Introduction: Intra-arrest percutaneous coronary intervention (PCI) has been proposed to increase survivorship from sudden out-of-hospital cardiac arrest (OHCA) that fails prehospital resuscitation. Given costs and system constraints to intra-arrest PCI, the ability to predict coronary ischemia as the cause of arrest may be beneficial to guide its performance.
HYPOTHESIS: We hypothesized that readily available prehospital information would predict coronary ischemia as the cause of OHCA amongst failed resuscitation attempts.
METHODS: Review of medical examiner reports for adult victims of OHCA for whom prehospital resuscitation was attempted. Data was linked to prehospital data documenting Utstein variables and patient demographics. Logistic regression was performed to generate a predictive model for coronary ischemia as the cause of arrest.
Results: 119 autopsy reports were identified. Of these, 68 (57%) were terminated in the field, 51 (43%) in the ED. Males composed 77% of the sample. Mean age was 50+14 years. Coronary ischemia was determined to be causative in 50/119 (40%) of failed arrests. A logistic regression model that included shockable rhythm (OR 13, 95% CI 4-47), age (OR 2 per decade of life, 95% CI 2-4), and male gender (OR 6, 95% CI 1-32) demonstrated an area under the receiver-operating curve of 0.88 and correctly classified 76% of cases. Predictive probabilities derived from the model can be used to predict individual risk (Figure).
CONCLUSIONS: In conclusion, the combination of an initial shockable rhythm, advanced age, and male gender are all highly predictive of acute coronary ischemia as the cause of OHCA.
- © 2013 by American Heart Association, Inc.