Objective This study describes the predictors of in‐hospital cardiac arrest (IHCA) within 24 h of ED triage and evaluates their ability to predict patients at risk of IHCA. Methods A case–control study was conducted in the ED. ‘Cases’ are herein defined as hospitalised patients who experienced IHCA within 24 h after ED triage. The exclusion criteria were those younger than 16 years old, cases of traumatic arrest, or had do‐not‐resuscitate orders. The controls were adults, non‐traumatic cases, who did not experience IHCA within 24 h of ED triage. A multivariable regression model was used to identify significant predictors of IHCA. The ability to discriminate was quantified by utilising an area under receiver operating characteristic (AuROC) curve. Results Two hundred and fifty IHCAs were compared with 1000 controls. Five predictors emerged that were: higher National Early Warning Score (NEWS) at triage, equal or increase of NEWS after ED management, coronary artery disease as a comorbid disease, the use of a vasoactive agent, and initial serum bicarbonate level lower than 23.5 mmoL/L, independently associated with IHCA. The AuROC of the final model from all predictors was 0.91 (95% CI 0.89–0.93) higher than NEWS alone model (AuROC at 0.78, 95% CI 0.74–0.81). Conclusions We conclude that a combination of NEWS and four independent predictors identify patients at risk of IHCA more effectively than NEWS alone.

Background Out‐of‐hospital cardiac arrest is an emergency that requires immediate management to save lives. However, some predictive scores for the immediate outcomes of patients with out‐of‐hospital cardiac arrest are difficult to use in clinical practice. Aims This study aimed to identify predictors of sustained return of spontaneous circulation and to develop a predictive score. Methods This prospective observational study evaluated sustained return of spontaneous circulation among out‐of‐hospital cardiac arrest patients in a Thai emergency department between July 2014 and March 2018. The baseline characteristics and prehospital and hospital findings were analysed. Results Of 347 patients, 126 (36.3%) had sustained return of spontaneous circulation and 20 (5.8%) were discharged. Witnessed arrest (odds ratio = 2.9, 95% confidence interval 1.3‐6.2), time from arrest to chest compression <15 min (odds ratio = 3.0, 95% confidence interval 1.3‐7.0) and chest compression duration <30 min (odds ratio = 15.6, 95% confidence interval 8.7‐28.0) predicted sustained return of spontaneous circulation; these were developed into the WATCH‐CPR (Witnessed Arrest, Time from arrest to CHest compression‐CPR duration) score. A score of ≥2 was optimal for predicting sustained return of spontaneous circulation, which provided an area under the receiver operating characteristic of 0.775 (95% confidence interval 0.724‐0.825) and a sensitivity of 72.2% (95% confidence interval 63.4‐79.6%) and specificity of 76.0% (95% confidence interval 69.8‐81.4%). Conclusions The factors including witnessed arrest, time from arrest to chest compression and chest compression duration were developed as the WATCH‐CPR score for predicting sustained return of spontaneous circulation among patients with out‐of‐hospital cardiac arrest.

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