Outcome of out-of-hospital cardiac arrest over a period of 15 years in comparison to the RACA score in a physician staffed urban emergency medical service in Germany

Schewe, Jens-Christian; Kappler, Jochen; Heister, Ulrich; Weber, Stefan; Diepenseifen, C. J.; Frings, Benjamin; Hoeft, Andreas; Fischer, Matthias

doi:10.1016/j.resuscitation.2015.07.025

Cited by 22 publications

(15 citation statements)

References 23 publications

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“…A total of 46.5 % of the patients achieved ROSC and 18.6% were discharged alive from the hospital. Although these figures are in accordance with ROSC rates in German registries ranging from 42.6-47.0%, and hospital discharge rates ranging from 9.8-10.4% in US registries to 13.8-16.6% in German registries (1)(2)(3)(4), the comparison of the observed ROSC rate with the value expected on the basis of the RACA algorithm (49.8%) does not indicate a positive impact of r-PA on this important outcome parameter. Therefore, although myocardial infarction was observed or suspected as the cause of the arrest in >80% of the patients, the results do not support the benefit of using fibrinolysis in achieving a higher ROSC rate in geographical regions with limited access to PCI and thus to increase the chances of subsequent interventional therapy in a cardiology centre.…”

Section: Discussionsupporting

confidence: 69%

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Outcome of out-of-hospital cardiac arrest after fibrinolysis with reteplase in comparison to the return of spontaneous circulation after cardiac arrest score in a geographic region without emergency coronary intervention

Luiz

Wilhelms

Madler

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Coronary occlusion and pulmonary embolism are responsible for the majority of cases of out-of-hospital cardiac arrest (OHCA). Despite previous favourable results of pre-hospital fibrinolysis in cases of OHCA, the benefit could not be confirmed in a large controlled study using the fibrinolytic tenecteplase. For reteplase (r-PA), there are hardly any data regarding pre-hospital fibrinolysis during ongoing resuscitation. The present study reported results using r-PA therapy in a German physician-supported Emergency Medical Services system. The data of OHCA patients who received pre-hospital fibrinolytic treatment with r-PA after an individual risk/benefit assessment were retrospectively analysed. To assess the effectiveness of this approach, the rate of patients with a return of spontaneous circulation (ROSC) was compared with the corresponding figure that was calculated with the help of the RACA (ROSC after cardiac arrest) score. The RACA algorithm predicts the probability of ROSC based on data from the German Resuscitation Registry. Further outcome data comprised hospital discharge rate and neurologic status at discharge. From 2001 to 2009, 43 patients (mean age, 58.5 years; 65.1% male; 58.1% ventricular fibrillation) received r-PA. Of these, 20 patients (46.5%) achieved ROSC, compared to a probability of 49.8% according to the RACA score (P=0.58). A total of 8 patients (18.6%) were discharged alive, including 5 (11.2%) with a good neurological outcome. For the analysed small patient collective, pre-hospital r-PA did not offer any benefits with regard to the ROSC rate. Further analyses of larger patient numbers on a nationwide registry basis are recommended.

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Section: Discussionsupporting

confidence: 69%

“…Although the prognosis of patients with out-of-hospital cardiac arrest (OHCA) has improved in certain parts of the world in recent years, 85-90% of patients still do not survive (1)(2)(3)(4). Intravascular thrombi in coronary or pulmonary arteries are the most frequent cause of OHCA (5,6).…”

Section: Introductionmentioning

confidence: 99%

Outcome of out-of-hospital cardiac arrest after fibrinolysis with reteplase in comparison to the return of spontaneous circulation after cardiac arrest score in a geographic region without emergency coronary intervention

Luiz

Wilhelms

Madler

et al. 2017

Experimental and Therapeutic Medicine

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“…In a previously published study RACA score was used to compare predicted and observed non-traumatic out-of-hospital cardiac arrest ROSC rates over three 5-year time periods in the EMS of Bonn, Germany, showing lower than observed ROSC rates in all time periods [20]. It was also used in another German study to compare ROSC rates in out-of-hospital cardiac arrest patients with difficult or unsuccessful intubations where predicted and observed ROSC rates were similar in the group of difficult intubations, while the unsuccessful intubation group had lower than predicted ROSC rates [21].…”

Section: Discussionmentioning

confidence: 99%

External validation of the ROSC after cardiac arrest (RACA) score in a physician staffed emergency medical service system

Kupari

Skrifvars

Kuisma

2017

Scand J Trauma Resusc Emerg Med

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BackgroundThe return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score may have implications as a quality indicator for the emergency medical services (EMS) system. We aimed to validate this score externally in a physician staffed urban EMS system.MethodsWe conducted a retrospective cohort study. Data on resuscitation attempts from the Helsinki EMS cardiac arrest registry from 1.1.2008 to 31.12.2010 were collected and analyzed. For each attempted resuscitation the RACA score variables were collected and the score calculated. The endpoint was ROSC defined as palpable pulse over 30 s. Calibration was assessed by comparing predicted and observed ROSC rates in the whole sample, separately for shockable and non-shockable rhythm, and separately for resuscitations lead by a specialist, registrar or medical supervisor (i.e., senior paramedic). Data are presented as medians and interquartile ranges. Statistical testing included chi-square test, the Mann-Whitney U test, Hosmer-Lemeshow goodness of fit test and calculation of 95% confidence intervals (CI) for proportions.ResultsA total of 680 patients were included of whom 340 attained ROSC. The RACA score was higher in patients with ROSC (0.62 [0.46–0.69] than in those without (0.46 [0.36–0.57]) (p < 0.001). Observed against predicted ROSC indicated reasonable calibration overall (p = 0.30), with better calibration in patients with a shockable initial rhythm (p = 0.75) than in patients with a non-shockable rhythm (p = 0.04). There was no statistical difference between observed and predicted ROSC rates in resuscitations attended by a specialist (50% vs 53%, 95% CI 45–55) or registrar (55% vs 53%, 95% CI 48–62), but rates were lower than predicted in resuscitations lead by a medical supervisor (36% vs 49%, 95% CI 25–47).DiscussionDeveloping a practical severity-of-illness scoring system for out-of-hospital cardiac arrest patients would allow patient heterogeneity adjustment and measurement of quality of care in analogy to commoly used severity-of-illness- scores developed for the similar purposes for the general intensive care unit population. However, transferring RACA score to another country with different population and EMS system might affect the performance and generalizability of the score.ConclusionsThis study found a good overall calibration and moderate discrimination of the RACA score in a physician staffed urban EMS system which suggests external validity of the score. Calibration was suboptimal in patients with a non-shockable rhythm which may due to a local do-not-attempt-resuscitation policy. The lower than expected overall ROSC rate in resuscitations attended by medical supervisors requires further study.

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“…Due to a higher incidence of cardio‐vascular morbidity in higher age and ageing of the population, out‐of‐hospital cardiac arrest (OHCA) is an increasing event and a global health issue . Studies have shown that the median age of patients suffering cardiac OHCA ranges between 60 and 70 years . Patient age may significantly impact decisions and treatment strategies for post‐resuscitation care .…”

Section: Introductionmentioning

confidence: 99%

“…4 Studies have shown that the median age of patients suffering cardiac OHCA ranges between 60 and 70 years. [5][6][7] Patient age may significantly impact decisions and treatment strategies for post-resuscitation care. 8,9 The chance of good neurologic outcome and survival after OHCA may be influenced by the increasing age, but cannot be generalised to be bad.…”

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confidence: 99%

Age‐dependent effect of targeted temperature management on outcome after cardiac arrest

Wallmüller

Spiel

Sterz

et al. 2018

Eur J Clin Investigation

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Outcome of out-of-hospital cardiac arrest over a period of 15 years in comparison to the RACA score in a physician staffed urban emergency medical service in Germany

Cited by 22 publications

References 23 publications

Outcome of out-of-hospital cardiac arrest after fibrinolysis with reteplase in comparison to the return of spontaneous circulation after cardiac arrest score in a geographic region without emergency coronary intervention

Outcome of out-of-hospital cardiac arrest after fibrinolysis with reteplase in comparison to the return of spontaneous circulation after cardiac arrest score in a geographic region without emergency coronary intervention

External validation of the ROSC after cardiac arrest (RACA) score in a physician staffed emergency medical service system

Age‐dependent effect of targeted temperature management on outcome after cardiac arrest

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