Prediction of return of spontaneous circulation in out-of-hospital cardiac arrest with non-shockable initial rhythm using point-of-care testing: a retrospective observational study

doi:10.5847/wjem.j.1920-8642.2023.031

Abstract

Abstract:

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a public health concern, and many studies have been conducted on return of spontaneous circulation (ROSC) and its prognostic factors. Rotational thromboelastometry (ROTEM^®), a point-of-care testing (POCT) method, has been useful for predicting ROSC in patients with OHCA, but very few studies have focused on patients with non-shockable rhythm. We examined whether the parameters of POCT could predict ROSC in patients with OHCA and accompanying non-shockable rhythm.

METHODS: This is a single-center, retrospective observational study. Complete blood count, blood gas, and ROTEM POCT measurements were used. This study included patients with non-traumatic OHCA aged 18 years or older who were transported to the emergency department and evaluated using POCT between January 2013 and December 2021. The patients were divided into the ROSC and non-ROSC groups. Prehospital information and POCT parameters were compared using receiver operating characteristic (ROC) curve analysis, and further logistic regression analysis was performed.

RESULTS: Sixty-seven and 135 patients were in the ROSC and non-ROSC groups, respectively. The ROC curves showed a high area under the curve (AUC) for K⁺ of 0.77 (95% confidence interval [CI]: 0.71-0.83) and EXTEM amplitude 5 min after clotting time (A5) of 0.70 (95%CI: 0.62-0.77). The odds ratios for ROSC were as follows: female sex 3.67 (95%CI: 1.67-8.04); K⁺ 0.64 (95%CI: 0.48-0.84); and EXTEM A5 1.03 (95%CI: 1.01-1.06).

CONCLUSION: In OHCA patients with non-shockable rhythm, K⁺ level and the ROTEM parameter EXTEM A5 may be useful in predicting ROSC.

Key words: Rotational thromboelastometry, Blood coagulation disorders, Extrinsic pathway, Potassium

Kota Shinada, Hiroyuki Koami, Ayaka Matsuoka, Yuichiro Sakamoto. Prediction of return of spontaneous circulation in out-of-hospital cardiac arrest with non-shockable initial rhythm using point-of-care testing: a retrospective observational study[J]. World Journal of Emergency Medicine, 2023, 14(2): 89-95.

Figures/Tables 5

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References 31

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Variables	All (n=202)	ROSC (n=67)	Non-ROSC (n=135)	P-value
Age, years, median (interquartile)	80 (68.8-87)	80 (73-87)	79 (66-87)	0.2068
Female, n (%)	84 (41.6)	39 (58.2)	45 (33.3)	0.0009
Witness, n (%)	64 (31.7)	34 (50.8)	30 (22.2)	<0.001
Bystander CPR, n (%)	104 (51.5)	32 (47.8)	72 (53.3)	0.5500
Initial rhythm, n (%)
PEA	49 (24.3)	25 (37.3)	24 (17.8)	0.0031
Asystole	153 (75.7)	42 (62.7)	111 (82.2)	0.0031
Physician-staffed EMS, n (%)	35 (17.3)	16 (23.9)	19 (14.1)	0.1131
Prehospital advanced airway management, n (%)	48 (23.8)	23 (34.3)	25 (18.5)	0.0217
Prehospital epinephrine administration, n (%)	43 (21.3)	18 (26.9)	25 (18.5)	0.2021
Time from EMS call to EMS arrival, min, median (interquartile)	11 (9-14)	11 (9-14)	11 (9-14)	0.8999
Time from EMS arrival to hospital arrival, min, median(interquartile)	23 (18-31)	25 (20-34)	22 (17-30)	0.0338
Cause of cardiac arrest, n (%)
Cardiac	188 (93.1)	59 (88.1)	129 (95.6)	0.0740
Respiratory	2 (1.0)	1 (1.5)	1 (0.7)	1.0000
Neurological	3 (1.5)	3 (4.5)	0 (0.0)	0.0354
Sepsis	3 (1.5)	2 (3.0)	1 (0.7)	0.2559
Hemorrhage	6 (3.0)	2 (3.0)	4 (3.0)	1.0000
Neck hanging	8 (4.0)	1 (1.5)	7 (5.2)	0.2743
Choking	22 (10.9)	17 (25.4)	5 (3.7)	<0.0001
Drowning	10 (5.0)	1 (1.5)	9 (6.7)	0.1699
Drug addiction	2 (1.0)	0 (0.0)	2 (1.5)	1.0000
Others	8 (4.0)	3 (4.5)	5 (3.7)	1.0000

POCT parameters	All (n=202)	ROSC (n=67)	Non-ROSC (n=135)	P-value
Complete blood count
White blood cell, /μL	9,100 (7,100-11,425)	9,400 (7,700-12,800)	9,000 (6,900-11,100)	0.1479
Hemoglobin, g/dL	11.1 (9.4-13.1)	10.8 (8.9-12.9)	11.3 (9.6-13.3)	0.1627
Platelet, 10⁴/μL	122 (77-184)	151 (102-198)	107 (62-168)	0.0026
Blood gas
pH	6.847 (6.750-6.951)	6.864 (6.790-6.962)	6.842 (6.701-6.939)	0.0393
pCO₂, mmHg	90.3 (68.2-110)	75.7 (61.0-96.6)	96 (72.4-115.5)	0.0002
pO₂, mmHg	29.2 (19.4-52.0)	31.2 (19.6-80.4)	28.9 (19.0-43.6)	0.0550
Sodium ion, mEq/L	141 (137-144)	141 (137-145)	140 (136-144)	0.4966
Potassium ion, mEq/L	6.8 (5.3-9.2)	5.5 (4.7-6.9)	8.1 (5.9-10.0)	<0.001
Chloride ion, mEq/L	102 (97-105)	103 (98-105)	101 (96-105)	0.2472
Actual base excess, mEq/L	-20.2 (-24.7--15.9)	-19.3 (-24.2--13.8)	-20.8 (-25--16.3)	0.1794
Bicarbonate ion, mEq/L	15.2 (11.1-18.8)	15.5 (10-19.2)	14.8 (11.7-17.9)	0.8537
Blood glucose, mg/dL	231 (137-352)	238 (156-342)	219 (129-355)	0.7277
Lactate, mmol/L	14.9 (10.8-18.0)	12.5 (9.4-17.0)	16.0 (12.5-19.0)	0.0003
ROTEM EXTEM
CT, s	90 (69-184)	74 (66-106)	108 (71-1430)	<0.001
A5, mm	30 (10-42)	36 (29-49)	22 (0-40)	<0.001
A10, mm	40 (6-53)	47 (37-59)	31 (0-50)	<0.001
A15, mm	40 (1-56)	52 (30-63)	35 (0-53)	0.0001
A20, mm	42 (0-58)	54 (22-65)	34 (0-55)	0.0002
A25, mm	42 (0-59)	55 (16-66)	21 (0-56)	0.0004
A30, mm	37 (0-58)	53 (2-65)	13 (0-53)	0.0005
MCF, mm	48 (16-60)	56 (44-67)	41 (0-57)	<0.001

Parameters	AUC	Youden’s index	Sensitivity (%)	Specificity (%)
Platelet	0.63	125	68.7	62.2
pH	0.59	6.781	81.8	37.9
pCO₂	0.66	85.2	63.6	64.9
Potassium ion	0.77	7.7	94.0	52.6
Lactate	0.66	14.3	62.1	64.8
CT	0.67	128	86.6	44.4
A5	0.70	28	79.1	61.7
A10	0.67	40	74.6	62.2
A15	0.67	43	70.2	64.4
A20	0.66	45	67.2	63.7
A25	0.65	48	62.7	66.7
A30	0.65	50	56.7	71.8
MCF	0.69	50	67.2	63.7

Variables	Odds ratio	95% confidence interval	P-value
Age	1.01	0.98-1.04	0.4536
Female	3.67	1.67-8.04	0.0012
Witness	1.68	0.72-3.91	0.2294
Bystander CPR	0.83	0.38-1.80	0.6311
Initial rhythm (PEA)	0.61	0.24-1.55	0.2956
Prehospital advanced airway management	1.82	0.65-5.05	0.2518
Prehospital epinephrine administration	0.35	0.11-1.08	0.0671
Time from EMS call to EMS arrival	0.98	0.89-1.08	0.6490
Time from EMS arrival to hospital arrival	1.02	0.98-1.06	0.4109
pCO₂	0.99	0.97-1.00	0.0533
Potassium ion	0.64	0.48-0.84	0.0018
Lactate	1.02	0.92-1.12	0.7299
ROTEM EXTEM A5	1.03	1.01-1.06	0.0029
	Nagelkerke R²=0.29
	P <0.001