Journal Article

External Validation of the RESCUE-IHCA Score as a Predictor for In-Hospital Cardiac Arrest Patients Receiving Extracorporeal Cardiopulmonary Resuscitation

Ho, Yi-Ju, Chi, Chien-Yu, Huang, Chien-Hua, Tsai, Min-Shan, Chen, Yih-Sharng, Su, Pei-I

2024

Overview

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) improves the prognosis of in-hospital cardiac arrest (IHCA). The six-factor RESCUE-IHCA score (resuscitation using ECPR during IHCA) was developed to predict outcomes of post-IHCA ECPR-treated adult patients. Our goal was to validate the score in an Asian medical center with a high volume and experience of ECPR performance and to compare the differences in patient characteristics between the current study and the original cohort in a 2022 observational study. Method: For this single-center, retrospective cohort study we enrolled 324 ECPR-treated adult IHCA patients. The primary outcome was in-hospital mortality. We used the area under the receiver operating curve (AUROC) to externally validate the RESCUE-IHCA score. The calibration of the model was tested by the decile calibration plot as well as Hosmer–Lemeshow goodness-of-fit with an associated P-value. Results: Of the 324 participants, 231 (71%) died before hospital discharge. The discriminative performance of the RESCUE-IHCA score was comparable with the originally validated cohort, with an AUC of 0.63. A prolonged duration of cardiac arrest was associated with an increased risk of mortality (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01–1.03, P = .006). An initial rhythm of ventricular tachycardia (OR 0.14, 95% CI 0.04–0.51, P = .003), ventricular fibrillation (OR 0.11, 95% CI 0.03–0.46, P = .003), and palpable pulse (OR 0.26, 95% CI 0.07–0.92, P = 0.04) were associated with a reduced mortality risk compared to asystole or pulseless electrical activity. In contrast to the original study, age (P = 0.28), resuscitation timing (P = 0.14), disease category (P = 0.18), and pre-existing renal insufficiency (P = 0.12) were not associated with in-hospital death. Conclusion: In external validation, the RESCUE-IHCA score exhibited performance comparable to its original validation within the single-center population. Further investigation on hospital experience, time-of-day effect, and specific disease categories is warranted to improve the selection criteria for ECPR candidates during IHCA.

• Publisher: University of California Digital Library - eScholarship,Department of Emergency Medicine, University of California, Irvine School of Medicine,eScholarship Publishing, University of California
• Subject: Aged / Cardiac arrest / Cardiopulmonary Resuscitation / CPR / Critical Care / Educational Special Issue: Original Research / Extracorporeal Membrane Oxygenation / Female / Heart Arrest - mortality / Heart Arrest - therapy / Hospital Mortality / Humans / Male / Middle Aged / Mortality / Prognosis / Retrospective Studies / ROC Curve