• Resuscitation · Apr 2020

    Validation of the ROSC After Cardiac Arrest (RACA) Score in Pan-Asian Out-of-Hospital Cardiac Arrest Patients.

    • Nan Liu, Ong Marcus Eng Hock MEH Health Services Research Centre, Singapore Health Services, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore; D, Ho Andrew Fu Wah AFW Department of Emergency Medicine, Singapore General Hospital, Singapore; SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapor, Pin Pin Pek, Tsung-Chien Lu, Pairoj Khruekarnchana, Kyoung Jun Song, Hideharu Tanaka, Ghulam Yasin Naroo, Han Nee Gan, Zhi Xiong Koh, Matthew Huei-Ming Ma, and PAROS Clinical Research Network.
    • Health Services Research Centre, Singapore Health Services, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore. Electronic address: liu.nan@duke-nus.edu.sg.
    • Resuscitation. 2020 Apr 1; 149: 53-59.

    AimSurvival is the most consistently captured outcome across countries for out-of-hospital cardiac arrests (OHCA), with return of spontaneous circulation (ROSC) representing the earliest endpoint for 'unbiased' initial resuscitation success. The ROSC after cardiac arrest (RACA) score was developed to predict ROSC and has been validated in several European countries. In this study, we aimed to evaluate the performance of RACA in a Pan-Asian population.MethodsWe conducted a retrospective analysis of data collected in the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. We included OHCA cases from seven communities (Japan, South Korea, Malaysia, Singapore, Taiwan, Thailand, and United Arab Emirates) between January 2009 and December 2012. Paediatric cases, cases that were conveyed by non-emergency medical services (EMS), and cases with incomplete records were excluded from the study.ResultsThe RACA score showed similar discrimination performance as the original German study and various European validation studies. However, it had poor calibration with the original constant regression coefficient, which was primarily due to the low ROSC rate (8.2%) in the PAROS cohort. The calibration performance of RACA significantly improved after the constant coefficient was modified to adjust for the disparity in ROSC rates between Asia and Europe.ConclusionThis is the largest validation study of the RACA score. RACA consistently performs well in both Pan-Asian and European communities and can thus be a valuable tool for evaluating EMS systems. However, to implement it, the constant coefficient has to be modified in the RACA formula with local historical data.Copyright © 2020 Elsevier B.V. All rights reserved.

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