There are nice studies in the U.S. defining and validating a rule that determines which patients are unlikely to have ROSC or survival to hospital discharge, e.g. BLS-TOR. This is a study from France that looks at people who do have ROSC to see, not just if they’ll survive, but survival where the patient is not severely disabled or vegetative. One of the nice things about Europe is that their cultural perception of “life” really has to do more with living, and not just simply “being alive”. So, whether we can actually implement something like this in the U.S. may be difficult.
It’s a chart review, which limits its quality to some extent. The other real issue I have with this OHCA score is its complexity – it incorporates initial rhythm, no-flow and low-flow intervals, and admission levels of creatinine and lactate. The U.S. validation cohort had 34% therapeutic hypothermia, which is pretty good – the derivation cohort was only at 11%. Predictors of good neurologic outcome, consistent with other articles: ventricular fibrillation, bystander CPR, lower creatinine and lactate.
Unfortunately, for this rule to get up to 100% specificity, the sensitivity drops to 19%. Alternatively, you could say that’s 20% of out-of-hospital arrest ROSC that shouldn’t have further intervention, which would be an important cost and medical resource utilization savings.
So, this is something that your colleagues in critical care are going to use to discuss prognosis, although I’d like to see something along these lines that helps attenuate the number of people we resuscitate until our post-resuscitation care demonstrates much, much improved outcomes.