Derivation and Validation of the SWAP Score for Very Early Prediction of Neurologic Outcome in Patients With Out-of-Hospital Cardiac Arrest

Shih, Hong-Mo; Chen, Yi-Chuan; Chen, Chihyu; Huang, Fen-Wei; Chang, Shih‐Sheng; Yu, Shao-Hua; Wu, Shang Liang; Chen, Wei-Kung

doi:10.1016/j.annemergmed.2019.01.017

Cited by 20 publications

(22 citation statements)

References 43 publications

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“…More than 2,500 patients with OHCA are referred to emergency medical services (EMS) each year in Taichung. In Taichung, EMTs provided mainly basic life support for patients with OHCA, including airway management with bag-valve-mask and laryngeal mask airway, chest compression, and shock as necessary with AED [14]. EMT needs to be trained 24 hours a year, and the BLS license needs to be renewed every two years.…”

Section: Study Design and Settingsmentioning

confidence: 99%

Dispatcher-Assisted Cardiopulmonary Resuscitation: Disparity between Urban and Rural Areas

Chen

et al. 2020

Emergency Medicine International

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Object. To compare the provision and effectiveness of dispatcher-assisted cardiopulmonary resuscitation (DACPR) in rural and urban areas. Methods. Patients with out-of-hospital cardiac arrest (OHCA) were prospectively registered in Taichung. The 29 districts of Taichung city were divided into urban and rural areas based on whether the population density is more than 1,000 people per square kilometer. Prehospital data were collected according to the Utstein-style template, and telephone auditory records were collected by a dispatch center. Results. 2,716 patients were enrolled during the study period. 88.4% OHCA occurred in urban areas and 11.6% in rural areas. 74.9% after dispatcher assistance, laypersons performed CPR in urban areas and 67.7% in rural areas (p=0.023). The proportion of laypersons continued CPR until an emergency medical technician’s (EMT) arrival was higher in the urban areas (59.57% vs 52.27%, p=0.039). Laypersons continued CPR until an EMT’ arrival would increase the chance of return of spontaneous circulation in urban and rural areas, with adjusted odds ratio (aOR) of 1.02, 95% confidence interval (CI) of 0.82–1.27, and aOR of 1.49, 95% CI of 0.80–2.80, respectively. Continued laypersons CPR until the EMT’ arrival also improved survival with favorable neurological function, with aOR of 1.16, 95% CI of 0.61–2.20 in urban areas and aOR of 2.90 95% CI of 0.18–46.81 in rural areas. Conclusion. Bystanders in urban areas exhibited higher ratio of acceptance of DACPR. However, after DACPR intervention, prognosis improvement was considerably higher in rural areas than in urban areas.

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Section: Study Design and Settingsmentioning

confidence: 99%

Dispatcher-Assisted Cardiopulmonary Resuscitation: Disparity between Urban and Rural Areas

Chen

et al. 2020

Emergency Medicine International

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“…On the basis of the concept of events-per-variable in the logistic regression analysis,18 we limited the number of variables to be entered to four, which is one-tenth of the number of events in the derivation cohort. The following on-scene information that was shown to be significantly associated with favourable outcomes in previous studies was analysed as candidates of the predictors: age,19–24 no-flow time,19 21 23 25 initial cardiac rhythm19–24 and arrest place 23 26…”

Section: Methodsmentioning

confidence: 99%

“…Initially, to determine optimum cut-off values for age and no-flow time for predicting favourable outcome, we used the Youden index (sensitivity+specificity–1)27 for each receiver operating characteristic analysis as in previous studies 20 21. Cut-off values providing maximised Youden index were calculated and rounded to the nearest 5 years for age and 5 min for no-flow time for clinical ease of use.…”

Section: Methodsmentioning

confidence: 99%

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Prehospital ABC (Age, Bystander and Cardiogram) scoring system to predict neurological outcomes of cardiopulmonary arrest on arrival: post hoc analysis of a multicentre prospective observational study

Uehara

Tagami²,

Hyodo³

et al. 2022

Emerg Med J

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BackgroundThere is currently limited evidence to guide prehospital identification of patients with cardiopulmonary arrest on arrival (CPAOA) to hospital who have potentially favourable neurological function. This study aimed to develop a simple scoring system that can be determined at the contact point with emergency medical services to predict neurological outcomes.MethodsWe analysed data from patients with CPAOA using a regional Japanese database (SOS-KANTO), from January 2012 to March 2013. Patients were randomly assigned into derivation and validation cohorts. Favourable neurological outcomes were defined as cerebral performance category 1 or 2. We developed a new scoring system using logistic regression analysis with the following predictors: age, no-flow time, initial cardiac rhythm and arrest place. The model was internally validated by assessing discrimination and calibration.ResultsAmong 4907 patients in the derivation cohort and 4908 patients in the validation cohort, the probabilities of favourable outcome were 0.9% and 0.8%, respectively. In the derivation cohort, age ≤70 years (OR 5.11; 95% CI 2.35 to 11.14), no-flow time ≤5 min (OR 4.06; 95% CI 2.06 to 8.01) and ventricular tachycardia or fibrillation as initial cardiac rhythm (OR 6.66; 95% CI 3.45 to 12.88) were identified as predictors of favourable outcome. The ABC score consisting of Age, information from Bystander and Cardiogram was created. The areas under the receiver operating characteristic curves of this score were 0.863 in the derivation and 0.885 in the validation cohorts. Positive likelihood ratios were 6.15 and 6.39 in patients with scores >2 points and were 11.06 and 17.75 in those with 3 points.ConclusionThe ABC score showed good accuracy for predicting favourable neurological outcomes in patients with CPAOA. This simple scoring system could potentially be used to select patients for extracorporeal cardiopulmonary resuscitation and minimise low-flow time.

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“…To produce a simpler score specific for the ED, the shockable rhythm‐witness‐age‐pH score was created 70 . This score was derived from a cohort of 852 out‐of‐hospital cardiac arrest patients using 4 variables: shockable initial rhythm, witnessed arrest status, age, and either arterial or venous pH.…”

Section: Scoring Systemsmentioning

confidence: 99%

Neurologic prognostication after resuscitation from cardiac arrest

2020

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Out‐of‐hospital cardiac arrest remains a leading cause of mortality in the United States, and the majority of patients who die after achieving return of spontaneous circulation die from withdrawal of care due to a perceived poor neurologic prognosis. Unfortunately, withdrawal of care often occurs during the first day of admission and research suggests this early withdrawal of care may be premature and result in unnecessary deaths for patients who would have made a full neurologic recovery. In this review, we explore the evidence for neurologic prognostication in the emergency department for patients who achieve return of spontaneous circulation after an out‐of‐hospital cardiac arrest.

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Derivation and Validation of the SWAP Score for Very Early Prediction of Neurologic Outcome in Patients With Out-of-Hospital Cardiac Arrest

Cited by 20 publications

References 43 publications

Dispatcher-Assisted Cardiopulmonary Resuscitation: Disparity between Urban and Rural Areas

Dispatcher-Assisted Cardiopulmonary Resuscitation: Disparity between Urban and Rural Areas

Prehospital ABC (Age, Bystander and Cardiogram) scoring system to predict neurological outcomes of cardiopulmonary arrest on arrival: post hoc analysis of a multicentre prospective observational study

Neurologic prognostication after resuscitation from cardiac arrest

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