계명대학교 의학도서관 Repository

External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era

Metadata Downloads
Author(s)
Haewon JungMi Jin LeeJae Wan ChoSang Hun LeeSuk Hee LeeYou Ho MunHan-sol ChungYang Hun KimGyun Moo KimSin-youl ParkJae Cheon JeonChangho Kim
Keimyung Author(s)
Lee, Sang Hun
Department
Dept. of Emergency Medicine (응급의학)
Journal Title
Scand J Trauma Resusc Emerg Med
Issued Date
2021
Volume
29
Keyword
Heart arrestPrognosisCoronavirus diseaseEthicsCardiopulmonary resuscitation
Abstract
Background:
Futile resuscitation for out-of-hospital cardiac arrest (OHCA) patients in the coronavirus disease (COVID)-19 era can lead to risk of disease transmission and unnecessary transport. Various existing basic or advanced life support (BLS or ALS, respectively) rules for the termination of resuscitation (TOR) have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era.

Methods:
This was a multicenter observational study using the WinCOVID-19 Daegu registry data collected during February 18–March 31, 2020. The subjects were patients who showed cardiac arrest of presumed cardiac etiology. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity, specificity, false positive value (FPV), and positive predictive value (PPV) of each TOR rule were evaluated.

Results:
In total, 170 of the 184 OHCA patients were eligible and evaluated. TOR was recommended for 122 patients based on the international basic life support termination of resuscitation (BLS-TOR) rule, which showed 85% specificity, 74% sensitivity, 0.8% FPV, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPV (upper limit of 95% confidence interval < 5%), specificity (100%), and PPV (> 99%) criteria, only the KoCARC TOR rule I, which included a combination of three factors including not being witnessed by emergency medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock delivery or return of spontaneous circulation, was found to be superior to all other TOR rules.

Conclusion:
Among the previous nine BLS and ALS TOR rules, KoCARC TOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide.
Keimyung Author(s)(Kor)
이상훈
전재천
Publisher
School of Medicine (의과대학)
Citation
Haewon Jung et al. (2021). External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era. Scand J Trauma Resusc Emerg Med, 29, 19. doi: 10.1186/s13049-021-00834-0
Type
Article
ISSN
1757-7241
Source
https://sjtrem.biomedcentral.com/articles/10.1186/s13049-021-00834-0
DOI
10.1186/s13049-021-00834-0
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43654
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학)
공개 및 라이선스
  • 공개 구분공개
파일 목록

Items in Repository are protected by copyright, with all rights reserved, unless otherwise indicated.