Abstract 16536: Construction and Validation of a New Termination-of-Resuscitation Rule for Out-of-Hospital Cardiac Arrest in the Japanese Population
Background: Termination of resuscitation (TOR) rules for out-of-hospital cardiac arrest (OHCA) have been constructed for better utilization of hospital healthcare resources and increasing the availability of care for other patients.
Objective: To validate the TOR-ALS rule in the Japanese population and to establish a new TOR rule for terminating ongoing resuscitation just after hospital arrival.
Methods: Data from a nationwide database of a prospective population-based cohort using an Utstein-style template for OHCA patients during January 2005 to December 2014 as used for the current analysis. We constructed a new TOR rule consisting of 5 factors (no-witness, no-ROSC, asystole for the initial rhythm, no-defibrillation, age) including the patients during 2005 to 2012 (derivation cohort). Statistical values to predict death and unfavorable neurological outcome(UNO) at one-month were calculated for the TOR-ALS rule (no-witness, no-bystander, no-return of spontaneous circulation (ROSC), no-defibrillation before hospital arrival) and the new rule, respectively. After constructing the new rule, we validated it in a cohort of patients during 2013 to 2014 (validation cohort).
Results: Of the 1,176,363 patients documented for the study period, 906,044 adult patients with OHCA without external causes of arrest were included in the present analysis. In the derivation cohort (n=705,560), values (sensitivity/specificity/PPV/NPV/AUC-ROC) to predict death for each rule were as followed; TOR-ALS rule (32.0%/95.9%/99.4%/5.9%/0.640), new rule (31.9%/98.2%/99.8%/6.0%/0.651). Values to predict UNO were, TOR-ALS rule (31.5%/98.4%/99.87%/3.3%/0.650), new rule (31.4%/99.4%/99.96%/3.3%/0.654). In the validation cohort (n=200,484), values to predict death were, TOR-ALS rule (27.4%/97.3%/99.5%/6.7%/0.623), new rule (33.1%/98.5%/99.7%/7.4%/0.658). Values to predict UNO were, TOR-ALS rule (26.8%/99.0%/99.89%/3.7%/0.629), new rule (32.4%/99.6%/99.97%/4.0%/0.660).
Conclusion: The new TOR rule has a higher PPV and specificity to predict unfavorable outcome of OHCA in a Japanese population.
Author Disclosures: K. Hashiba: None. Y. Tahara: None. K. Kimura: None. S. Yasuda: None. S. Kojima: None. H. Ogawa: None. N. Yonemoto: None. H. Nonogi: None. K. Saku: None. K. Nagao: None.
- © 2016 by American Heart Association, Inc.