The following is a summary of “Point-of-care testing for adult out-of-hospital cardiac arrest resuscitated at the ED to predict ROSC: Development and external validation of POC-ED-ROSC model,” published in the September 2023 issue of Emergency Medicine by Huang, et al.
Existing prediction models, such as Return of Spontaneous Circulation (ROSC) after Cardiac Arrest (RACA) or Utstein-based (UB)-ROSC score, have primarily been developed for prehospital settings. These models aimed to predict the likelihood of ROSC in patients with out-of-hospital cardiac arrest (OHCA). However, a specific prediction model for the probability of ROSC in OHCA patients in emergency departments (EDs) still needs to be developed. For a study, researchers sought to develop and validate a point-of-care (POC) testing-based model, referred to as POC-ED-ROSC, to predict the occurrence of ROSC in OHCA patients at EDs.
The study analyzed prospectively collected data for adult OHCA patients between 2015 and 2020. The primary focus was POC blood gas analysis conducted within 5 minutes of ED arrival. The primary outcome assessed was ROSC. A multivariable logistic regression was employed in the derivation cohort to create the POC-ED-ROSC model. In the temporally split validation cohort, the model’s discriminative performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Using the DeLong test, it was then compared with the RACA and UB-ROSC scores. The study encompassed 606 patients in the derivation cohort and 270 patients in the validation cohort. Among the total cohort, 471 patients achieved ROSC. The significant predictors included in the POC-ED-ROSC model were age, the initial cardiac rhythm at the ED, pre-hospital resuscitation duration, and POC testing-measured blood levels of lactate, potassium, and glucose. The model exhibited fair discriminative performance in the validation cohort, with an AUC of 0.75 (95% CI: 0.69–0.81). Notably, there were no significant differences between the performance of the POC-ED-ROSC model and the RACA or UB-ROSC score, which had AUCs of 0.68 (95% CI: 0.62–0.74) and 0.74 (95% CI: 0.68–0.79), respectively.
The POC-ED-ROSC model, utilizing just six easily accessible variables, can predict ROSC in OHCA patients resuscitated at the ED fairly.