Prediction of Prehospital Change of the Cardiac Rhythm From Nonshockable to Shockable in Out‐of‐Hospital Patients With Cardiac Arrest: A Post Hoc Analysis of a Nationwide, Multicenter, Prospective Registry

R. Emoto, M. Nishikimi, M. Shoaib, Kei Hayashida, Kazuki Nishida, K. Kikutani, S. Ohshimo, S. Matsui, N. Shime, T. Iwami
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Abstract

Background Predicting a spontaneous rhythm change from nonshockable to shockable before hospital arrival in patients with out‐of‐hospital cardiac arrest can help emergency medical services develop better strategies for prehospital treatment. The aim of this study was to identify predictors of spontaneous rhythm change before hospital arrival in patients with out‐of‐hospital cardiac arrest and develop a predictive scoring system. Methods and Results We retrospectively reviewed data of eligible patients with out‐of‐hospital cardiac arrest with an initial nonshockable rhythm registered in a nationwide registry between June 2014 and December 2017. We performed a multivariable analysis using a Cox proportional hazards model to identify predictors of a spontaneous rhythm change, and a ridge regression model for predicting it. The data of 25 804 patients were analyzed (derivation cohort, n=17 743; validation cohort, n=8061). The rhythm change event rate was 4.1% (724/17 743) in the derivation cohort, and 4.0% (326/8061) in the validation cohorts. Age, sex, presence of a witness, initial rhythm, chest compression by a bystander, shock with an automated external defibrillator by a bystander, and cause of the cardiac arrest were all found to be independently associated with spontaneous rhythm change before hospital arrival. Based on this finding, we developed and validated the Rhythm Change Before Hospital Arrival for Nonshockable score. The Harrell’s concordance index values of the score were 0.71 and 0.67 in the internal and external validations, respectively. Conclusions Seven factors were identified as predictors of a spontaneous rhythm change from nonshockable to shockable before hospital arrival. We developed and validated a score to predict rhythm change before hospital arrival.
院外心脏骤停患者院前心律从非休克到休克变化的预测:一项全国性、多中心、前瞻性登记的事后分析
背景:在院外心脏骤停患者到达医院前预测从非休克到休克的自发节律变化可以帮助急救医疗机构制定更好的院前治疗策略。本研究的目的是确定院外心脏骤停患者入院前自发性心律变化的预测因素,并开发一种预测评分系统。方法和结果我们回顾性回顾了2014年6月至2017年12月在全国登记的具有初始非震荡心律的院外心脏骤停患者的数据。我们使用Cox比例风险模型进行多变量分析,以确定自发节律变化的预测因素,并使用脊回归模型进行预测。分析25 804例患者的资料(衍生队列,n=17 743;验证队列,n=8061)。衍生队列的节律变化事件率为4.1%(724/17 743),验证队列的节律变化事件率为4.0%(326/8061)。年龄、性别、证人在场、初始心律、旁观者胸部按压、旁观者使用自动体外除颤器电击以及心脏骤停原因均被发现与到达医院前的自发心律变化独立相关。基于这一发现,我们开发并验证了非休克住院前的心律变化评分。在内部和外部验证中,得分的Harrell’s一致性指数分别为0.71和0.67。结论确定了7个因素可作为到达医院前从非休克到休克的自发节律变化的预测因素。我们开发并验证了一个评分来预测住院前的心律变化。
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