Background
Methods
Statistical analysis
Outcome at 6 months | Adjusted for agea
| |||
---|---|---|---|---|
CPC 1–2 (n = 440) | CPC 3–5 (n = 493) | OR (95% CI)b
|
p Value | |
Age, years | 61 (52–69) | 68 (61–76) | 1.06 (1.05–1.07) | <0.0001 |
Female sex | 66 (15) | 111 (23) | 1.69 (1.18–2.43) | 0.004 |
BMI (5/20)c
| 25.3 (23.4–27.8) | 26.1 (23.9–29.4) | 1.05 (1.01–1.08) | 0.006 |
Alcoholism (0/2) | 10 (2) | 26 (5) | 3.12 (1.45–6.71) | 0.004 |
COPD/asthma (0/1) | 31 (7) | 65 (13) | 1.62 (1.01–2.58) | 0.04 |
Previous heart failure (0/3) | 16 (4) | 44 (9) | 1.75 (0.95–3.22) | 0.07 |
Diabetes (2/4) | 51 (12) | 89 (18) | 1.41 (0.96–2.08) | 0.08 |
CABG (0/4) | 26 (6) | 62 (13) | 1.49 (0.90–2.44) | 0.12 |
TIA/stroke (1/3) | 23 (5) | 50 (10) | 1.51 (0.89–2.57) | 0.13 |
Malignancy (3/4) | 9 (2) | 22 (4) | 1.89 (0.82–4.35) | 0.13 |
Epilepsy (1/1) | 11 (3) | 5 (1) | 0.46 (0.15–1.47) | 0.19 |
Arrhythmia (0/2) | 60 (14) | 103 (21) | 1.26 (0.87–1.83) | 0.21 |
ICD (3/1) | 1 (<1) | 4 (<1) | 3.77 (0.40–35.44) | 0.25 |
Hypertension (1/3) | 150 (34) | 222 (45) | 1.15 (0.86–1.52) | 0.35 |
Dialysis (0/1) | 2 (<1) | 4 (<1) | 1.78 (0.32–10.10) | 0.51 |
IHD (1/2) | 101 (23) | 157 (32) | 1.10 (0.80–1.50) | 0.57 |
Intravenous drug abuse (2/1) | 2 (<1) | 2 (<1) | 1.67 (0.21–13.04) | 0.63 |
Pacemaker (2/2) | 11 (3) | 21 (4) | 1.17 (0.54–2.52) | 0.68 |
Cardiac valve surgery (1/4) | 10 (2) | 15 (3) | 1.17 (0.50–2.73) | 0.71 |
PCI (0/4) | 45 (10) | 62 (13) | 1.08 (0.70–1.65) | 0.73 |
Previous cardiac arrest (0/2) | 9 (2) | 12 (2) | 1.13 (0.44–2.91) | 0.79 |
Immunodeficiency (2/1) | 2 (<1) | 2 (<1) | 1.16 (0.14–9.25) | 0.89 |
Previous AMI (0/2) | 79 (18) | 112 (23) | 0.99 (0.70–1.39) | 0.94 |
Cirrhosis (0/1) | 0 (0) | 3 (<1) | ||
AIDS (4/4) | 1 (<1) | 0 (0) |
Outcome at 6 months | Adjusted for age | |||
---|---|---|---|---|
CPC 1–2 (n = 440) | CPC 3–5 (n = 493) | OR (95% CI)a
|
p Value | |
CA at home (0/1)b
| 192 (44) | 306 (62) | 2.16 (1.64–2.85) | <0.0001 |
Witnessed (0/1) | 406 (92) | 427 (87) | 0.61 (0.39–0.97) | 0.04 |
Bystander CPR (0/2) | 347 (79) | 331 (67) | 0.61 (0.45–0.83) | 0.002 |
First monitored rhythm other than VT/VF (0/1) | 38 (9) | 169 (34) | 5.14 (3.46–7.64) | <0.0001 |
Intubation (6/8) | 273 (63) | 352 (73) | 1.67 (1.24–2.25) | 0.0007 |
CA until BLS (73/141) | 1 (0–2) | 1 (0–3) | 1.10 (1.04–1.17) | 0.0005 |
CA until ALS (8/8) | 8 (5–11) | 10 (7–15) | 1.07 (1.04–1.10) | <0.0001 |
CA until ROSC (0/1) | 20 (14–30) | 31 (21–47) | 1.57 (1.42–1.72)c
| <0.0001 |
No flowd (2/4) | 1 (0–3) | 2 (0–8) | 1.09 (1.05–1.12) | <0.0001 |
Low flowe (0/1) | 19 (12–27) | 27 (17–40) | 1.43 (1.31–1.56)c
| <0.0001 |
Adrenaline (3/2) | 258 (59) | 423 (86) | 4.62 (3.29–6.48) | <0.0001 |
Seizures (1/2) | 33 (8) | 23 (5) | 0.64 (0.36–1.15) | 0.14 |
Automatic compression (0/3) | 92 (21) | 127 (26) | 1.27 (0.92–1.75) | 0.15 |
Outcome at 6 months | Adjusted for age | ||||
---|---|---|---|---|---|
CPC 1–2 (n = 440) | CPC 3–5 (n = 493) |
p Value | OR (95% CI)a
|
p Value | |
Initial temperature (12/23)b
| 35.5 (34.9–36.0) | 35.3 (34.4–36.0) | 0.002 | 0.11 (0.03–0.47) | 0.003 |
Pupillary/corneal reflex (8/36) | 392 (91) | 327 (72) | <0.0001 | 0.27 (0.18–0.40) | <0.0001 |
Cough reflex (45/59) | 277 (70) | 211 (49) | <0.0001 | 0.41 (0.30–0.55) | <0.0001 |
Spontaneous breathing (15/22) | 310 (73) | 284 (60) | <0.0001 | 0.57 (0.43–0.77) | 0.0002 |
GCS-M1 (1/6) | 173 (39) | 316 (65) | <0.0001 | 2.79 (2.11–3.70) | <0.0001 |
pH (24/20) | 7.27 (7.17–7.32) | 7.19 (7.05–7.28) | <0.0001 | 0.02 (0.01–0.06) | <0.0001 |
Lactate (36/25) | 4.6 (2.4–8.1) | 6.9 (3.9–10.6) | <0.0001 | 1.84 (1.55–2.20)c
| <0.0001 |
Creatinine (13/17) | 95 (80–115) | 115 (90–140) | <0.0001 | 3.36 (2.14–5.29)d
| <0.0001 |
Blood glucose (32/20) | 12.4 (9.4–16.0) | 14.0 (10.6–18.0) | <0.0001 | 1.08 (1.06–1.12) | <0.0001 |
PaCO2 (31/25) | 0.0006 | 0.0004 | |||
<4.5 kPa | 40 (10) | 66 (14) | 1.96 (1.22–3.16) | ||
>6.0 kPa | 191 (47) | 256 (55) | 1.75 (1.29–2.38) | ||
Base excess (40/26) | −6 (−10, −4) | −10 (−15, −5) | <0.0001 | 0.93 (0.91–0.95) | <0.0001 |
Potassium (15/13) | 3.7 (3.4–4.2) | 4.0 (3.5–4.5) | <0.0001 | 1.55 (1.29–1.87) | <0.0001 |
Shock at admission (0/1) | 36 (8) | 100 (20) | <0.0001 | 2.70 (1.77–4.13) | <0.0001 |
PaO2 > 40 kPa (35/35) | 64 (16) | 95 (21) | 0.07 | 1.38 (0.96–2.00) | 0.09 |
FiO2, % (11/20) | 80 (50–100) | 90 (53–100) | 0.21 | 1.00 (1.00–1.01) | 0.25 |
Acute STEMI/LBBB (2/8) | 217 (50) | 220 (45) | 0.21 | 0.96 (0.73–1.26) | 0.77 |
Results
Variables associated with a poor outcome
Independent predictors of a poor outcome
OR (95% CI) |
p Value | β- Coefficient | |
---|---|---|---|
Age, years | 1.07 (1.05–1.08) | <0.0001 | 0.0644 |
CA at home | 1.75 (1.26–2.44) | 0.0008 | 0.5620 |
First monitored rhythm other than VT/VF | 4.06 (2.55–6.46) | <0.0001 | 1.4014 |
No flow, minutes | 1.06 (1.02–1.10) | 0.002 | 0.0578 |
Low flow, minutes | 1.28 (1.15–1.42)a
| <0.0001 | 0.2430 |
Treatment with adrenaline | 2.08 (1.39–3.11) | 0.0003 | 0.7342 |
No pupillary or corneal reflex | 2.46 (1.58–3.85) | <0.0001 | 0.9016 |
pH | 0.10 (0.03–0.34) | 0.0003 | 2.3308 |
GCS motor score 1b
| 2.00 (1.44–2.77) | <0.0001 | 0.6927 |
PaCO2 < 4.5 kPa | 2.53 (1.46–4.39) | 0.0009 | 0.9293 |
A simple risk score for a poor outcome: performance and validation
Risk factor | Categories | Points |
---|---|---|
Age, years | <40 | −1 |
40–44 | 0 | |
45–49 | 1 | |
50–54 | 2 | |
55–59 | 3 | |
60–64 | 4 | |
65–69 | 5 | |
70–74 | 6 | |
75–79 | 7 | |
80–84 | 8 | |
≥85 | 9 | |
CA at home | No | 0 |
Yes | 2 | |
First monitored rhythm other than VT/VF | No | 0 |
Yes | 4 | |
No flow | 0–4 | 0 |
5–9 | 1 | |
10–14 | 2 | |
≥15 | 3 | |
Low flow | 0–5 | 0 |
6–15 | 1 | |
16–30 | 2 | |
31–60 | 3 | |
>60 | 4 | |
Treatment with adrenaline | No | 0 |
Yes | 2 | |
No pupillary or corneal reflex | No | 0 |
Yes | 3 | |
pH | ≥7.35 | −1 |
7.20–7.34 | 0 | |
7.05–7.19 | 1 | |
6.90–7.04 | 2 | |
<6.90 | 3 | |
GCS motor score 1 | No | 0 |
Yes | 2 | |
PaCO2 < 4.5 kPa | No | 0 |
Yes | 3 |
Risk score | Scores | ||
---|---|---|---|
TTM risk score | >10 | >13 | >16 |
n (%) | 612–615 (66–66) | 410–417 (44–45) | 217–221 (23–24) |
Sensitivity, % | 86–87 | 69–70 | 40–41 |
Specificity, % | 57–58 | 83–84 | 95–96 |
PPV, % | 69–70 | 82–83 | 91–91 |
NPV, % | 79–80 | 71–71 | 59–59 |
CAHP risk score | >150 | >200 | |
n (%) | 711–716 (76–77) | 312–318 (33–34) | |
Sensitivity, % | 91–91 | 48–49 | |
Specificity, % | 39–40 | 82–83 | |
PPV, % | 63–63 | 76–76 | |
NPV, % | 79–79 | 59–59 | |
OHCA risk score | >2.0 | >17.4 | >32.5 |
n (%) | 829–833 (89–89) | 565–574 (62–62) | 266–271 (29–29) |
Sensitivity, % | 94–94 | 77–78 | 44–45 |
Specificity, % | 16–17 | 56–58 | 89–89 |
PPV, % | 56–56 | 66–67 | 82–82 |
NPV, % | 71–73 | 69–70 | 59–59 |