Association between prehospital FPS and ROSC in adults with OHCA : A retrospective multicenter study using the German Resuscitation Registry and Intubation Registry (FiPS-CPR)

Sustained Return of Spontaneous Circulation Following Out-of-Hospital Cardiac Arrest; Developing a Predictive Model Based on Multivariate Analysis

Introduction

Identifying the predictive factors of sustained return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) will be helpful in management of these patients. This study aimed to develop a predictive model in this regard.

Methods

In a retrospective observational study, data of adult patients with OHCA, were collected from Vajira emergency medical services patient care report. Multiple logistic regression analysis with a regression coefficient was used to develop a predictive score for a sustained ROSC at the scene. Area under the receiver operating characteristic (ROC) curve (AUC) was used to validate the accuracy of the predictive score for a sustained ROSC.

Results

Independent factors associated with a sustained ROSC included cardiopulmonary resuscitation (CPR) duration < 30 min (adjusted odds ratio (AOR)= 5.05, 95% confidence interval (CI): 3.34-7.65; p < 0.001); advanced airway management with an endotracheal tube (AOR= 3.06, 95% CI: 1.77-5.31; p < 0.001); advanced airway management with laryngeal mask airway (AOR= 3.42, 95% CI: 1.02-11.46; p = 0.046); defibrillation (AOR = 2.05, 95% CI: 1.31-3.2; p = 0.002); Capillary blood glucose (CBG) level < 150 mg% (AOR= 1.95, 95% CI: 1.05-3.65; p = 0.035); CBG at least 150 mg% (AOR= 2.87, 95% CI: 1.56-5.29; p = 0.001); pupil reflex (AOR = 2.96, 95% CI: 1.1-7.96; p = 0.032); and response time at most 8 min (AOR= 1.66, 95% CI: 1.07-2.57; p = 0.023). These were developed into the pupil reflex, response time, advanced airway management, defibrillation, CBG, and CPR duration (PRAD-CCPR) score. The most accurate cutoff point of score using Youden's index was ≥ 6 with AUC of 0.759 (95% CI: 0.715-0.802; p < 0.001), sensitivity of 62.0% (95% CI: 51.2-71.9%), specificity of 75.7% (95% CI: 69.4-81.2%), positive predictive value of 51.8% (95% CI: 40.9-62.3%), and negative predictive value of 79.5% (95% CI: 73.5-84.6%).

Conclusion

An optimal PRAD-CCPR score of ≥ 6 provides an acceptable accuracy of 0.759 with sensitivity of 62.0% and specificity of 75.7% in prediction of sustained ROSC following OHCA. This predictive score might help CPR commanders to prognosticate the outcome of patients with OHCA at the scene.

Effect of video laryngoscopy for non-trauma out-of-hospital cardiac arrest on clinical outcome: A registry-based analysis

AIM

Videolaryngoscopy (VL) is a promising tool to provide a safe airway during cardiopulmonary resuscitation (CPR) and to ensure early reoxygenation. Using data from the German Resuscitation Registry, we investigated the outcome of non-traumatic out-of-hospital cardiac arrest (OHCA) patients treated with VL versus direct laryngoscopy (DL) for airway management.

METHODS

We analysed retrospective data of 14,387 patients from 1 January 2018 until 31 December 2021 (VL group, n = 2201; DL group, n = 12186). Primary endpoint was discharge with cerebral performance categories one and two (CPC1/2). Secondary endpoints were the rate of return of spontaneous circulation (ROSC), hospital admission, hospital admission with ongoing cardiopulmonary resuscitation, 30-day survival/ hospital discharge and airway management complications. We used multivariate binary logistic regression analysis to identify the effects on outcome of known influencing variables and of VL vs DL.

RESULTS

The multivariate regression model revealed that VL was an independent predictor of CPC1/2 survival (OR = 1.34, 95% CI = 1.12-1.61, p = 0.002) and of hospital discharge/30-day survival (OR = 1.26, 95% CI = 1.08-1.47, p = 0,004).

CONCLUSION

VL for endotracheal intubation (ETI) at OHCA was associated with better neurological outcome in patients with ROSC. Therefore, the use of VL for OHCA offers a promising perspective. Further prospective studies are required.