Prehospital prediction of survival after out-of-hospital cardiac arrest using point-of-care testing and vital signs: a prospective, multinational study

Prehospital vital signs and point-of-care testing (POCT) analytical biomarkers may have the potential to predict the outcome in out-of-hospital cardiac arrest (OHCA). The aim was to develop the first score for predicting survival to hospital discharge (STHD) based on the combination of prehospital vital signs and POCT physiologic parameters. A prospective, multinational and ambulance-based study was conducted in OHCA patients with return of spontaneous circulation (ROSC) managed by emergency medical services and transferred with high priority to the emergency department. The vital signs and analytical biomarkers were obtained post-ROSC. A total of 203 OHCA patients with ROSC from two cohorts were used. The predictive score was based on the lactate, Glasgow Coma Scale (GCS) score, creatinine, mean arterial pressure (MAP), pulse oximetry saturation/fraction of inspired oxygen ratio (SaFi), pH and potassium. The discriminative power in terms of area under the curve (AUC) were 0.937 (95%CI:0.878–0.995) and 0.892 (95%CI:0.776-1) in the Spanish and Austrian cohorts, respectively. A combination of prehospital vital signs and POCT biomarkers shows potential for predicting STHD in this preliminary analysis. However, given the small size of the external validation cohort, the score requires further large-scale, prospective validation before any conclusions regarding clinical implementation can be drawn. At its current stage of development, the score is not ready for clinical use.