Predictive model of return of spontaneous circulation among patients with out‐of‐hospital cardiac arrest in Thailand: The WATCH‐CPR Score

Abstract

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.

Prognostic value of C‐reactive protein to albumin ratio in patients resuscitated from out‐of‐hospital cardiac arrest

“…All these changes cause systemic ischemia and multiorgan failure. 4,11 Therefore, it is very important to assess the prognosis after CPR and to predict survival early and accurately in patients who survived from CA.…”

“…After that, some complex pathophysiological changes occur such as free oxygen radical production, increased vascular permeability and disruption of the blood‐brain barrier. All these changes cause systemic ischemia and multiorgan failure 4,11 . Therefore, it is very important to assess the prognosis after CPR and to predict survival early and accurately in patients who survived from CA.…”

Association between C-reactive protein-to-albumin ratio and 6-month mortality in out-of-hospital cardiac arrest

“…Systemic inflammation also occurs in patients with PCAS and ischemic injury. During cardiac arrest, the inflammatory response increases vascular permeability and destroys the blood-brain barrier (BBB), causing multiorgan ischemia, including in the brain [ 3 , 16 ]. CRP is an inflammatory biomarker that may be correlated with the severity of hypoxic brain damage following cardiac arrest.…”

Characteristics and outcomes of out-of-hospital cardiac arrest patients before and during the COVID-19 pandemic in Thailand

“…Additionally, the generalized linear regression with a log link and Gaussian distribution robust variance estimation to analyze risk difference. We reviewed the literature for the covariates which affected the outcomes (11,(32)(33)(34)(35). The outcomes were adjusted for the following variables: age, comorbidities, cardiac etiology, public location, bystander CPR, EMS response, initial shockable rhythm, and mode of chest compression.…”