Termination of resuscitation in out-of-hospital cardiac arrest in women and men: An ESCAPE-NET project. (April 2023)

• Record Type: Journal Article
• Authors: Smits, R.L.A.; Sødergren, S.T.F.; van Schuppen, H.; Folke, F.; Ringh, M.; Jonsson, M.; Motazedi, E.; van Valkengoed, I.G.M.; Tan, H.L.
• Is Part Of: Resuscitation. Volume 185(2023)
• Publication Date: 2023-04
• Subjects: Out-of-Hospital Cardiac Arrest -- Advanced Life Support -- Termination of resuscitation -- Women and men; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2023.109721
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: 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.