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Prognostic indicators and outcome prediction model for patients with return of spontaneous circulation from cardiopulmonary arrest: the Utstein Osaka Project |
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| Authors: | Hayakawa Koichi Tasaki Osamu Hamasaki Toshimitsu Sakai Tomohiko Shiozaki Tadahiko Nakagawa Yuko Ogura Hiroshi Kuwagata Yasuyuki Kajino Kentaro Iwami Taku Nishiuchi Tatsuya Hayashi Yasuyuki Hiraide Atsushi Sugimoto Hisashi Shimazu Takeshi |
| Affiliation: | a Osaka Neurological Institute, 2-6-23 Shounaitakaramachi, Toyonaka City, Osaka 561-0836, Japan b Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-Oka, Suita City, Osaka 565-0871, Japan c Department of Biomedical Statistics, Osaka University Graduate School of Medicine, 2-15 Yamada-Oka, Suita City, Osaka 565-0871, Japan d Emergency and Critical Care Medical Center, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka City, Osaka 543-0035, Japan e Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto City, Kyoto 606-8501, Japan f Department of Critical Care and Emergency Medicine, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City 545-0051, Japan g Senri Critical Care Medical Center, Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita City, Osaka 565-0862, Japan h Emergency Room, Kinki University Hospital, 377-2 Ono-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan i Hoshigaoka Koseinenkin Hospital, 4-8-1 Hoshigaoka, Hirakata City, Osaka 573-8511, Japan |
| Abstract: | ObjectiveTo determine the most important indicators of prognosis in patients with return of spontaneous circulation (ROSC) following out-of-hospital cardiopulmonary arrest (OHCA) and to develop a best outcome prediction model.Design and patientsAll patients were prospectively recorded based on the Utstein Style in Osaka over a period of 3 years (2005-2007). Criteria for inclusion were a witnessed cardiac arrest, age greater than 17 years, presumed cardiac origin of the arrest, and successful ROSC. Multivariate logistic regression (MLR) analysis was used to develop the best prediction model. The dependent variables were favourable outcome (cerebral-performance category [CPC]: 1-2) and poor outcome (CPC: 3-5) at 1 month after the event. Eight explanatory pre-hospital variables were used concerning patient characteristics and resuscitation. External validation was performed on an independent set of Utstein data in 2007.ResultsSubjects comprised 285 patients in VF and 577 patients with pulseless electrical activity (PEA)/asystole. The percentage of favourable outcomes was 31.9% (91/285) in VF and 5.7% (33/577) in PEA/asystole. The most important prognostic indicators of favourable outcome found by MLR were age (p = 0.10), time from collapse to ROSC (TROSC) (p < 0.01), and presence of pre-hospital ROSC (PROSC) (p = 0.15) for VF and age (p = 0.03), TROSC (p < 0.01), PROSC (p < 0.01), and conversion to VF (p = 0.01) for PEA/asystole. For external validation data, areas under the receiver-operating characteristic curve were 0.867 for VF and 0.873 for PEA/asystole.ConclusionsA model based on four selected indicators showed a high predictive value for favourable outcome in OHCA patients with ROSC. |
| Keywords: | Cardiac arrest Emergency medical service Out-of-hospital CPR Pulseless electrical activity Return of spontaneous circulation Utstein template Ventricular fibrillation Witnessed cardiac arrest |
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