PMID- 37278780 OWN - NLM STAT- MEDLINE DCOM- 20230608 LR - 20230701 IS - 1936-9018 (Electronic) IS - 1936-900X (Print) IS - 1936-900X (Linking) VI - 24 IP - 3 DP - 2023 Apr 4 TI - End-tidal Carbon Dioxide + Return of Spontaneous Circulation After Cardiac Arrest (RACA) Score to Predict Outcomes After Out-of-hospital Cardiac Arrest. PG - 605-614 LID - 10.5811/westjem.59005 [doi] AB - INTRODUCTION: The return of spontaneous circulation after cardiac arrest (RACA) score is a well-validated model for estimating the probability of return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA) by incorporating several variables, including gender, age, arrest aetiology, witness status, arrest location, initial cardiac rhythms, bystander cardiopulmonary resuscitation (CPR), and emergency medical services (EMS) arrival time. The RACA score was initially designed for comparisons between different EMS systems by standardising ROSC rates. End-tidal carbon dioxide (EtCO(2)) is a quality indicator of CPR. We aimed to improve the performance of the RACA score by adding minimum EtCO(2) measured during CPR to develop the EtCO(2) + RACA score for OHCA patients transported to an emergency department (ED). METHODS: This was a retrospective analysis using prospectively collected data for OHCA patients resuscitated at an ED during 2015-2020. Adult patients with advanced airways inserted and available EtCO(2) measurements were included. We used the EtCO(2) values recorded in the ED for analysis. The primary outcome was ROSC. In the derivation cohort, we used multivariable logistic regression to develop the model. In the temporally split validation cohort, we assessed the discriminative performance of the EtCO(2) + RACA score by the area under the receiver operating characteristic curve (AUC) and compared it with the RACA score using the DeLong test. RESULTS: There were 530 and 228 patients in the derivation and validation cohorts, respectively. The median measurements of EtCO(2) were 8.0 times (interquartile range [IQR] 3.0-12.0 times), with the median minimum EtCO(2) of 15.5 millimeters of mercury (mm Hg) (IQR 8.0-26.0 mm Hg). The median RACA score was 36.4% (IQR 28.9-48.0%), and a total of 393 patients (51.8%) achieved ROSC. The EtCO(2) + RACA score was validated with good discriminative performance (AUC, 0.82, 95% CI 0.77-0.88), outperforming the RACA score (AUC, 0.71, 95% CI 0.65-0.78) (DeLong test: P < 0.001). CONCLUSION: The EtCO(2) + RACA score may facilitate the decision-making process regarding allocations of medical resources in EDs for OHCA resuscitation. FAU - Wu, Cheng-Yi AU - Wu CY AD - National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan. FAU - Lu, Tsung-Chien AU - Lu TC AD - National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan. AD - National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan. FAU - Su, Pei-I AU - Su PI AD - National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan. FAU - Tsai, Chu-Lin AU - Tsai CL AD - National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan. AD - National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan. FAU - Tay, Joyce AU - Tay J AD - National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan. FAU - Wu, Meng-Che AU - Wu MC AD - National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan. FAU - Yen, Yi-Hsuan AU - Yen YH AD - Baylor Scott and White All Saints Medical Center, Department of Emergency Medicine, Fort Worth, TX. AD - Baylor University Medical Center, Department of Emergency Medicine, Dallas, TX. FAU - Chou, Eric H AU - Chou EH AD - Baylor Scott and White All Saints Medical Center, Department of Emergency Medicine, Fort Worth, TX. AD - Baylor University Medical Center, Department of Emergency Medicine, Dallas, TX. FAU - Wang, Chih-Hung AU - Wang CH AD - National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan. AD - National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan. FAU - Huang, Chien-Hua AU - Huang CH AD - National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan. AD - National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan. FAU - Chen, Wen-Jone AU - Chen WJ AD - National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan. AD - National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan. AD - National Taiwan University Hospital and National Taiwan University College of Medicine, Department of Internal Medicine, Division of Cardiology, Taipei, Taiwan. AD - Min-Shen General Hospital, Taoyuan, Taiwan. LA - eng PT - Journal Article DEP - 20230404 PL - United States TA - West J Emerg Med JT - The western journal of emergency medicine JID - 101476450 RN - 142M471B3J (Carbon Dioxide) SB - IM MH - Adult MH - Humans MH - *Out-of-Hospital Cardiac Arrest/therapy MH - Carbon Dioxide MH - Return of Spontaneous Circulation MH - Retrospective Studies MH - *Cardiopulmonary Resuscitation MH - *Emergency Medical Services PMC - PMC10284512 COIS- Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare. EDAT- 2023/06/06 13:10 MHDA- 2023/06/08 06:42 PMCR- 2023/05/01 CRDT- 2023/06/06 11:06 PHST- 2022/09/25 00:00 [received] PHST- 2023/01/24 00:00 [accepted] PHST- 2023/06/08 06:42 [medline] PHST- 2023/06/06 13:10 [pubmed] PHST- 2023/06/06 11:06 [entrez] PHST- 2023/05/01 00:00 [pmc-release] AID - westjem.59005 [pii] AID - wjem-24-605 [pii] AID - 10.5811/westjem.59005 [doi] PST - epublish SO - West J Emerg Med. 2023 Apr 4;24(3):605-614. doi: 10.5811/westjem.59005.