TY - JOUR
T1 - Termination of resuscitation in out-of-hospital cardiac arrest in women and men
T2 - An ESCAPE-NET project
AU - Smits, R. L. A.
AU - Sødergren, S. T. F.
AU - van Schuppen, H.
AU - Folke, F.
AU - Ringh, M.
AU - Jonsson, M.
AU - Motazedi, E.
AU - van Valkengoed, I. G. M.
AU - Tan, H. L.
N1 - Funding Information: The authors thank all those contributing to the ARREST study: participating EMS dispatch centres (Amsterdam, Haarlem, Alkmaar), regional ambulance services (Ambulance Amsterdam, GGD Kennemerland, Witte Kruis, Veiligheidsregio Noord-Holland Noord Ambulancezorg), fire brigades, police departments, and Schiphol airport, for their cooperation and support. We greatly appreciate the contributions of Vera van Eeden and Remy Stieglis of the Academic Medical Center (Amsterdam, The Netherlands), to the data collection, data entry, and patient follow-up, and of Dr. R.W. Koster for the acquisition of funding. We thank all students of the ARREST team who helped collect the automated external defibrillator data. Publisher Copyright: © 2023 The Author(s)
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Aim: Women have less favorable resuscitation characteristics than men. We investigated whether the Advanced Life Support Termination of Resuscitation rule (ALS-TOR) performs equally in women and men. Additionally, we studied whether adding or removing criteria from the ALS-TOR improved classification into survivors and non-survivors. Methods: We analyzed 6,931 female and 14,548 male out-of-hospital cardiac arrest (OHCA) patients from Dutch and Swedish registries, and validated in 10,772 female and 21,808 male Danish OHCA patients. Performance measures were calculated for ALS-TOR in relation to 30-day survival. Recursive partitioning analysis was performed with the ALS-TOR criteria, as well as age, comorbidities, and additional resuscitation characteristics (e.g. initial rhythm, OHCA location). Finally, we explored if we could reduce the number of ALS-TOR criteria without loss of prognostic value. Results: The ALS-TOR had a specificity and positive predictive value (PPV) of ≥99% in both women and men (e.g. PPV 99.9 in men). Classification by recursive partitioning analysis showed a high sensitivity but a PPV below 99%, thereby exceeding the acceptable miss rate of 1%. A combination of no return of spontaneous circulation (ROSC) before transport to the hospital and unwitnessed OHCA resulted in nearly equal specificity and PPV, higher sensitivity, and a lower transport rate to the hospital than the ALS-TOR. Conclusion: For both women and men, the ALS-TOR has high specificity and low miss rate for predicting 30-day OHCA survival. We could not improve the classification with additional characteristics. Employing a simplified version may decrease the number of futile transports to the hospital.
AB - Aim: Women have less favorable resuscitation characteristics than men. We investigated whether the Advanced Life Support Termination of Resuscitation rule (ALS-TOR) performs equally in women and men. Additionally, we studied whether adding or removing criteria from the ALS-TOR improved classification into survivors and non-survivors. Methods: We analyzed 6,931 female and 14,548 male out-of-hospital cardiac arrest (OHCA) patients from Dutch and Swedish registries, and validated in 10,772 female and 21,808 male Danish OHCA patients. Performance measures were calculated for ALS-TOR in relation to 30-day survival. Recursive partitioning analysis was performed with the ALS-TOR criteria, as well as age, comorbidities, and additional resuscitation characteristics (e.g. initial rhythm, OHCA location). Finally, we explored if we could reduce the number of ALS-TOR criteria without loss of prognostic value. Results: The ALS-TOR had a specificity and positive predictive value (PPV) of ≥99% in both women and men (e.g. PPV 99.9 in men). Classification by recursive partitioning analysis showed a high sensitivity but a PPV below 99%, thereby exceeding the acceptable miss rate of 1%. A combination of no return of spontaneous circulation (ROSC) before transport to the hospital and unwitnessed OHCA resulted in nearly equal specificity and PPV, higher sensitivity, and a lower transport rate to the hospital than the ALS-TOR. Conclusion: For both women and men, the ALS-TOR has high specificity and low miss rate for predicting 30-day OHCA survival. We could not improve the classification with additional characteristics. Employing a simplified version may decrease the number of futile transports to the hospital.
KW - Advanced Life Support
KW - Out-of-Hospital Cardiac Arrest
KW - Termination of resuscitation
KW - Women and men
UR - http://www.scopus.com/inward/record.url?scp=85149067934&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.resuscitation.2023.109721
DO - https://doi.org/10.1016/j.resuscitation.2023.109721
M3 - Article
C2 - 36791988
SN - 0300-9572
VL - 185
JO - Resuscitation
JF - Resuscitation
M1 - 109721
ER -