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{ "pk": 18601, "title": "External Validation of the RESCUE-IHCA Score as a Predictor for In-Hospital Cardiac Arrest Patients Receiving Extracorporeal Cardiopulmonary Resuscitation", "subtitle": null, "abstract": "<p><strong>Background: </strong>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.</p>\n<p><strong>Method: </strong>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.</p>\n<p><strong>Results: </strong>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.</p>\n<p><strong>Conclusion: </strong>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.</p>", "language": null, "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "in-hospital cardiac arrest (IHCA)" }, { "word": "extracorporeal cardiopulmonary resuscitation (ECPR)" }, { "word": "extracorporeal membrane oxygenation (ECMO)" }, { "word": "prediction model" }, { "word": "external validation" } ], "section": "Critical Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0jh443kt", "frozenauthors": [ { "first_name": "Yi-Ju", "middle_name": "", "last_name": "Ho", "name_suffix": "", "institution": "National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan", "department": "None" }, { "first_name": "Pei-I", "middle_name": "", "last_name": "Su", "name_suffix": "", "institution": "National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan", "department": "None" }, { "first_name": "Chien-Yu", "middle_name": "", "last_name": "Chi", "name_suffix": "", "institution": "National Taiwan University Hospital Yun-Lin Branch, Department of Emergency Medicine, Yun-Lin, Taiwan", "department": "None" }, { "first_name": "Min-Shan", "middle_name": "", "last_name": "Tsai", "name_suffix": "", "institution": "National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University Hospital, Department of Internal Medicine, Taipei, Taiwan", "department": "None" }, { "first_name": "Yih-Sharng", "middle_name": "", "last_name": "Chen", "name_suffix": "", "institution": "National Taiwan University Hospital, Department of Surgery, Taipei, Taiwan; National Taiwan University, College of Medicine, Department of Surgery, Taipei, Taiwan", "department": "None" }, { "first_name": "Chien-Hua", "middle_name": "", "last_name": "Huang", "name_suffix": "", "institution": "National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University Hospital, Department of Internal Medicine, Taipei, Taiwan", "department": "" } ], "date_submitted": "2023-11-28T10:37:59Z", "date_accepted": "2024-07-27T14:43:01.790000Z", "date_published": "2024-10-04T13:00:00Z", "render_galley": { "label": "Final Article", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/18601/galley/26719/download/" }, "galleys": [ { "label": "Layout", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/18601/galley/25981/download/" }, { "label": "Final Article", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/18601/galley/26719/download/" } ] }