Predicting 28-Day Survival in OHCA Patients

NCT ID: NCT07023159

Last Updated: 2025-06-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

327 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-05-01

Study Completion Date

2024-06-01

Brief Summary

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This prospective study aimed to identify clinical and laboratory predictors of return of spontaneous circulation (ROSC), 28-day survival, and favorable neurological outcomes in adult patients experiencing out-of-hospital cardiac arrest (OHCA) and brought to the emergency department (ED) by emergency medical services (EMS). Specifically, the prognostic value of hematologic, biochemical, and blood gas parameters on admission was assessed for ROSC, 28-day survival, and favorable neurological recovery. Additionally, the study investigated the influence of key patient-centered and prehospital variables, including demographic features, initial cardiac rhythm, and the timeliness and type of cardiopulmonary resuscitation (CPR), defibrillation, and airway interventions, on overall survival and neurological status.

Detailed Description

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This prospective, observational, and cross-sectional study was conducted in the ED of a tertiary urban hospital between May 2023 and May 2024. Adult patients (aged ≥18 years) who experienced OHCA and received attempted resuscitation by EMS personnel were screened for eligibility. All patients received advanced cardiac life support (ACLS) in accordance with the 2021 European Resuscitation Council (ERC) and 2020 American Heart Association (AHA) guidelines.

Patients were initially categorized into survivors and non-survivors based on ROSC and 28-day survival status. Furthermore, 28-day survivors were stratified into two subgroups based on their neurological status using the Cerebral Performance Category (CPC) score. Favorable neurological outcome was defined as CPC 1-2 (good to moderate cerebral performance with independence), while CPC 3-5 (severe disability, coma, or death) constituted unfavorable outcome.

Prior to the initiation of the study, a standardized and pre-piloted data collection form was developed based on current literature to ensure consistency and reproducibility. During the study period, patient data were initially recorded by board-certified emergency medicine specialists who were on duty in the ED at the time of each patient's arrival. These attending physicians were directly responsible for patient management and completed the data forms either during the resuscitation process or immediately thereafter. All physicians involved in data entry were blinded to the study hypothesis. Subsequently, all collected data were extracted, cross-checked, and verified for accuracy and completeness by an emergency medicine specialist with eight years of clinical experience, who was also blinded to the study hypothesis.

Patient data were obtained from multiple sources, including hospital's automated systems and ED's archives, prehospital EMS reports, and the national digital healthcare database of Türkiye (e-Nabız), which was used to verify survival status and neurological outcomes at 28 days.

Collected data includes, demographics (age, sex), comorbidities (hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, or malignancy), and prehospital variables such as whether the cardiac arrest was witnessed, whether bystander CPR was performed, the time from collapse to the initiation of CPR, the time from collapse to EMS arrival, the durations of no-flow (time without CPR) and low-flow (time with CPR but no ROSC), and the initial cardiac rhythm, categorized as ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT), asystole, or pulseless electrical activity (PEA). The airway management method used by EMS was also recorded, including BVM, SGD, or ETI. Other recorded interventions included prehospital defibrillation, epinephrine administration (including total dose), and the use of mechanical chest compression devices. Whether ROSC was achieved in the field prior to ED arrival was also documented.

On arrival to the ED, clinical examination findings included the patient's body temperature, the Glasgow Coma Score (if measurable), the presence or absence of pupillary light reflex, and the requirement for vasopressor support within the first hour.

Laboratory data obtained upon admission included hematological parameters such as white blood cell count (WBC), hemoglobin level, platelet count, mean platelet volume (MPV), neutrophil count, monocyte count, and eosinophil count. Biochemical measurements included creatinine, urea, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), sodium, potassium, chloride, calcium, and troponin-I levels. Arterial blood gas analysis results included pH, partial pressure of carbon dioxide (pCO₂), bicarbonate, lactate concentration, carboxyhemoglobin percentage, and methemoglobin percentage.

Clinical outcomes, including ROSC, 28-day survival or mortality, and neurological status, were also recorded.

Patients' demographics, initial rhythm, prehospital intubation status, and hematological, biochemical, and blood gas parameters on admission were compared to identify factors associated with 28-day survival and neurological status between the groups. Independent predictors of survival were determined via multivariate logistic regression analysis of variables that significantly differed between survivors and non-survivors.

Conditions

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Out of Hospital Cardiac Arrest Cardiac Arrest (CA)

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Survivors

Survivors were defined as the patient being alive at 28 days following the cardiac arrest event.

Demographics

Intervention Type OTHER

The demographic profile of each patient was documented, including age and sex, to examine potential associations with survival and neurological outcomes.

Comorbidities

Intervention Type OTHER

Data on pre-existing chronic conditions were recorded, such as hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, and malignancy, in order to assess their potential impact on prognosis following OHCA.

Prehospital Variables

Intervention Type OTHER

Several prehospital factors were evaluated, including whether the cardiac arrest was witnessed, whether bystander CPR was performed, the time from collapse to the initiation of CPR, and the time from collapse to EMS arrival. Additionally, the durations of no-flow (i.e., time without any CPR) and low-flow (i.e., time with CPR but without ROSC) were noted. The initial cardiac rhythm was categorized as ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT), asystole, or pulseless electrical activity (PEA). Airway management methods used in the field were documented and classified as bag-valve-mask (BVM), supraglottic airway devices (SGAs), or endotracheal intubation (ETI). Other recorded interventions included prehospital defibrillation, administration of epinephrine (including total dosage), and use of mechanical chest compression devices. Whether ROSC was achieved prior to arrival at the emergency department was also noted.

Hematological Parameters

Intervention Type DIAGNOSTIC_TEST

These included white blood cell count (WBC), hemoglobin level, platelet count, mean platelet volume (MPV), and differential counts such as neutrophils, monocytes, and eosinophils.

Biochemical Parameters

Intervention Type DIAGNOSTIC_TEST

Measurements included creatinine, urea, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), sodium, potassium, chloride, calcium, and troponin-I levels.

Arterial Blood Gas Parameters

Intervention Type DIAGNOSTIC_TEST

The primary clinical outcomes recorded for each patient included return of spontaneous circulation (ROSC), 28-day survival or mortality, and neurological status, which was later assessed using the Cerebral Performance Category (CPC) scale.

Non-survivors

Non-survivors had passed away within 28 days following the cardiac arrest event.

Demographics

Intervention Type OTHER

The demographic profile of each patient was documented, including age and sex, to examine potential associations with survival and neurological outcomes.

Comorbidities

Intervention Type OTHER

Data on pre-existing chronic conditions were recorded, such as hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, and malignancy, in order to assess their potential impact on prognosis following OHCA.

Prehospital Variables

Intervention Type OTHER

Several prehospital factors were evaluated, including whether the cardiac arrest was witnessed, whether bystander CPR was performed, the time from collapse to the initiation of CPR, and the time from collapse to EMS arrival. Additionally, the durations of no-flow (i.e., time without any CPR) and low-flow (i.e., time with CPR but without ROSC) were noted. The initial cardiac rhythm was categorized as ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT), asystole, or pulseless electrical activity (PEA). Airway management methods used in the field were documented and classified as bag-valve-mask (BVM), supraglottic airway devices (SGAs), or endotracheal intubation (ETI). Other recorded interventions included prehospital defibrillation, administration of epinephrine (including total dosage), and use of mechanical chest compression devices. Whether ROSC was achieved prior to arrival at the emergency department was also noted.

Hematological Parameters

Intervention Type DIAGNOSTIC_TEST

These included white blood cell count (WBC), hemoglobin level, platelet count, mean platelet volume (MPV), and differential counts such as neutrophils, monocytes, and eosinophils.

Biochemical Parameters

Intervention Type DIAGNOSTIC_TEST

Measurements included creatinine, urea, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), sodium, potassium, chloride, calcium, and troponin-I levels.

Arterial Blood Gas Parameters

Intervention Type DIAGNOSTIC_TEST

The primary clinical outcomes recorded for each patient included return of spontaneous circulation (ROSC), 28-day survival or mortality, and neurological status, which was later assessed using the Cerebral Performance Category (CPC) scale.

Interventions

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Demographics

The demographic profile of each patient was documented, including age and sex, to examine potential associations with survival and neurological outcomes.

Intervention Type OTHER

Comorbidities

Data on pre-existing chronic conditions were recorded, such as hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, and malignancy, in order to assess their potential impact on prognosis following OHCA.

Intervention Type OTHER

Prehospital Variables

Several prehospital factors were evaluated, including whether the cardiac arrest was witnessed, whether bystander CPR was performed, the time from collapse to the initiation of CPR, and the time from collapse to EMS arrival. Additionally, the durations of no-flow (i.e., time without any CPR) and low-flow (i.e., time with CPR but without ROSC) were noted. The initial cardiac rhythm was categorized as ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT), asystole, or pulseless electrical activity (PEA). Airway management methods used in the field were documented and classified as bag-valve-mask (BVM), supraglottic airway devices (SGAs), or endotracheal intubation (ETI). Other recorded interventions included prehospital defibrillation, administration of epinephrine (including total dosage), and use of mechanical chest compression devices. Whether ROSC was achieved prior to arrival at the emergency department was also noted.

Intervention Type OTHER

Hematological Parameters

These included white blood cell count (WBC), hemoglobin level, platelet count, mean platelet volume (MPV), and differential counts such as neutrophils, monocytes, and eosinophils.

Intervention Type DIAGNOSTIC_TEST

Biochemical Parameters

Measurements included creatinine, urea, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), sodium, potassium, chloride, calcium, and troponin-I levels.

Intervention Type DIAGNOSTIC_TEST

Arterial Blood Gas Parameters

The primary clinical outcomes recorded for each patient included return of spontaneous circulation (ROSC), 28-day survival or mortality, and neurological status, which was later assessed using the Cerebral Performance Category (CPC) scale.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

\- This study included 420 adult patients (aged ≥18 years) who were brought to our hospital's ED due to OHCA and who had initiated attempted resuscitation by EMS were initially screened for inclusion between May 2023 and May 2024.

Exclusion Criteria

* Patients aged \< 18 years
* Patients with in-hospital cardiac arrest
* Patients who have suffered cardiac arrest due to major trauma, drowning, drug overdose, or known terminal illness
* Patients with active hematologic malignancy
* Patients with incomplete data regarding primary outcomes or admission laboratory tests
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Haseki Training and Research Hospital

OTHER

Sponsor Role lead

Responsible Party

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Adem Az

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Adem Az

Role: PRINCIPAL_INVESTIGATOR

Haseki Training and Research Hospital

Locations

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Haseki Training and Research Hospital

Istanbul, Sultangazi, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Soholm H, Wachtell K, Nielsen SL, Bro-Jeppesen J, Pedersen F, Wanscher M, Boesgaard S, Moller JE, Hassager C, Kjaergaard J. Tertiary centres have improved survival compared to other hospitals in the Copenhagen area after out-of-hospital cardiac arrest. Resuscitation. 2013 Feb;84(2):162-7. doi: 10.1016/j.resuscitation.2012.06.029. Epub 2012 Jul 13.

Reference Type BACKGROUND
PMID: 22796541 (View on PubMed)

Bro-Jeppesen J, Kjaergaard J, Horsted TI, Wanscher MC, Nielsen SL, Rasmussen LS, Hassager C. The impact of therapeutic hypothermia on neurological function and quality of life after cardiac arrest. Resuscitation. 2009 Feb;80(2):171-6. doi: 10.1016/j.resuscitation.2008.09.009. Epub 2008 Dec 25.

Reference Type BACKGROUND
PMID: 19111378 (View on PubMed)

Jabre P, Penaloza A, Pinero D, Duchateau FX, Borron SW, Javaudin F, Richard O, de Longueville D, Bouilleau G, Devaud ML, Heidet M, Lejeune C, Fauroux S, Greingor JL, Manara A, Hubert JC, Guihard B, Vermylen O, Lievens P, Auffret Y, Maisondieu C, Huet S, Claessens B, Lapostolle F, Javaud N, Reuter PG, Baker E, Vicaut E, Adnet F. Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory Arrest: A Randomized Clinical Trial. JAMA. 2018 Feb 27;319(8):779-787. doi: 10.1001/jama.2018.0156.

Reference Type BACKGROUND
PMID: 29486039 (View on PubMed)

Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, Colella MR, Herren H, Hansen M, Richmond NJ, Puyana JCJ, Aufderheide TP, Gray RE, Gray PC, Verkest M, Owens PC, Brienza AM, Sternig KJ, May SJ, Sopko GR, Weisfeldt ML, Nichol G. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2018 Aug 28;320(8):769-778. doi: 10.1001/jama.2018.7044.

Reference Type BACKGROUND
PMID: 30167699 (View on PubMed)

Strnad M, Borovnik Lesjak V, Jerot P, Esih M. Prehospital Predictors of Survival in Patients with Out-of-Hospital Cardiac Arrest. Medicina (Kaunas). 2023 Sep 26;59(10):1717. doi: 10.3390/medicina59101717.

Reference Type BACKGROUND
PMID: 37893434 (View on PubMed)

Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH; International Liaison Committee on Resuscitation. Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation. Circulation. 2022 Mar 29;145(13):e776-e801. doi: 10.1161/CIR.0000000000001013. Epub 2022 Feb 15.

Reference Type BACKGROUND
PMID: 35164535 (View on PubMed)

Other Identifiers

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01-2023

Identifier Type: -

Identifier Source: org_study_id

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