Validation of Utstein-Based score to predict Return Of Spontaneous Circulation (UB-ROSC) in patients with out-of-hospital cardiac arrest

Abstract

ABSTRACTBackgroundPrediction of probability of return of spontaneous circulation (ROSC) during out-of-hospital cardiac arrest (OHCA) is one of the biggest challenge in resuscitation science. The Utstein Based-ROSC (UB-ROSC) score has been developed to predict ROSC in OHCA’s victims. Aim of the study was to validate UB-ROSC score using two large Utstein-based OHCA registries: the SWiss REgistry of Cardiac Arrest (SWISSRECA) and the Lombardia Cardiac Arrest Registry (Lombardia CARe), northern Italy.MethodsConsecutive OHCA of any etiology occurring between January 1st, 2019 and December 31stand registered in 2 large national registries were included in a prospectively designed validation study. For model validation, a model area under the ROC curve (AUC ROC) for discrimination, using 10-fold cross-validation was computed. The score was plotted against the survival to hospital admission.Results14,715 patients were included in the study. A sustained ROSC was obtained in 3,151 patients (21%). Overall, UB-ROSC model showed a good discrimination (AUC 0.72, 95% CI 0.71-0.73). Shape of risk predicted by the model was almost linear and the model resulted well calibrated. In the low likelihood subgroup of UB-ROSC, only 9% of patients achieved a ROSC. This proportion raised to 35% for UB-ROSC score between −18 and 12 (OR 5.3, 95% CI 2.9-9.4, P<0.001). Finally, in 85% of patients with UB-ROSC values of more than or equal to 13 a ROSC was obtained (OR 52.1, 95%CI 15.6-173.0, P <0.001).ConclusionsUB-ROSC score may represent a reliable tool to predict ROSC probability. Its application may help the decision-making process providing a realistic stratification of probability of ROSC achievement.Clinical perspectivesWhat is new?-UB-ROSC is the unique Utstein-based score designed to help EMS staff to stratify patient’s probability of ROSC before treating the patient.-In this validation study, UB-ROSC score was verified in a cohort of more than 14,000 OHCA and confirmed a very high power in discrimination of ROSC probability-The score is very user-friendly and may be considered a helpful tool for EMS in the decision-making process when approaching OHCA victims.What are the clinical implications?-Sudden cardiac death is the leading causes of death worldwide and substantially contribute to loss of health and excess health system costs.-Development and validation of models to stratify probability of survival are increasingly necessary in the decision-making process, particularly in a pre-hospital setting, to offer a realistic expectation of survival and eventually to terminate resuscitation attempts.