title: Prognostic indicators and outcome prediction model for patients with return of spontaneous circulation from cardiopulmonary arrest: the Utstein Osaka Project.
abstract: OBJECTIVE
  To determine the most important indicators of prognosis in patients with return of spontaneous circulation (ROSC) following out-of-hospital cardiopulmonary arrest (OHCA) and to develop a best outcome prediction model.
  
  
  METHODS
  All patients were prospectively recorded based on the Utstein Style in Osaka over a period of 3 years (2005-2007). Criteria for inclusion were a witnessed cardiac arrest, age greater than 17 years, presumed cardiac origin of the arrest, and successful ROSC. Multivariate logistic regression (MLR) analysis was used to develop the best prediction model. The dependent variables were favourable outcome (cerebral-performance category [CPC]: 1-2) and poor outcome (CPC: 3-5) at 1 month after the event. Eight explanatory pre-hospital variables were used concerning patient characteristics and resuscitation. External validation was performed on an independent set of Utstein data in 2007.
  
  
  RESULTS
  Subjects comprised 285 patients in VF and 577 patients with pulseless electrical activity (PEA)/asystole. The percentage of favourable outcomes was 31.9% (91/285) in VF and 5.7% (33/577) in PEA/asystole. The most important prognostic indicators of favourable outcome found by MLR were age (p=0.10), time from collapse to ROSC (TROSC) (p<0.01), and presence of pre-hospital ROSC (PROSC) (p=0.15) for VF and age (p=0.03), TROSC (p<0.01), PROSC (p<0.01), and conversion to VF (p=0.01) for PEA/asystole. For external validation data, areas under the receiver-operating characteristic curve were 0.867 for VF and 0.873 for PEA/asystole.
  
  
  CONCLUSIONS
  A model based on four selected indicators showed a high predictive value for favourable outcome in OHCA patients with ROSC.
authors.affiliation: Osaka Neurological Institute, 2-6-23 Shounaitakaramachi, Toyonaka City, Osaka 561-0836, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hayakawa
authors.forename: Osamu
authors.initials: O
authors.lastname: Tasaki
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Hamasaki
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sakai
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Shiozaki
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogura
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kuwagata
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kajino
authors.forename: Taku
authors.initials: T
authors.lastname: Iwami
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishiuchi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiraide
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimazu
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D020127:Recovery of Function / Q000502:physiology*; D015996:Survival Rate / Q000639:trends