EPOS-OHCA: Early Predictors of Outcome and Survival after non-traumatic Out-of-Hospital Cardiac Arrest

Abstract

Background: Post-cardiac arrest syndrome (PCAS) after out-of-hospital cardiac arrest (OHCA) poses significant challenges due to its complex pathomechanisms involving inflammation, ischemia, and reperfusion injury. The identification of early available prognostic indicators is essential for optimizing therapeutic decisions and improving patient outcomes.

Methods: In this retrospective single-center study, we analyzed real-world data from 463 OHCA patients with either prehospital or in-hospital return of spontaneous circulation (ROSC), treated at the Cardiac Arrest Center of the University Hospital of Marburg (MCAC) from January 2018 to December 2022. We evaluated demographic, prehospital, and clinical variables, including initial rhythms, resuscitation details, and early laboratory results. Statistical analyses included logistic regression to identify predictors of survival and neurological outcomes.

Results: Overall, 46.9% (n = 217) of patients survived to discharge, with 70.1% (n = 152) achieving favorable neurological status (CPC 1 or 2). Age, initial shockable rhythm, resuscitation time to return of spontaneous circulation (ROSC), and early laboratory parameters like lactate, C-reactive protein, and glomerular filtration rate were identified as independent and combined Early Predictors of Outcome and Survival (EPOS), with high significant predictive value for survival (AUC 0.86 [95% CI 0.82-0.89]) and favorable neurological outcome (AUC 0.84 [95% CI 0.80-0.88]).

Conclusion: Integration of EPOS into clinical procedures may significantly improve clinical decision making and thus patient prognosis in the early time-crucial period after OHCA. However, further validation in other patient cohorts is needed.

Keywords: Out-of-hospital cardiac arrest (OHCA); Outcome; Post-resuscitation management; Prognostic parameters.

Fig. 1

Significant predictors identified by multiple regression analysis − defined as Early Predictors of Survival and Outcome (EPOS) after OHCA. A: age (years), Mean (SD); B: initial shockable rhythm (%); C: resuscitation time > 20 min (%), D: baseline lactate level (mmol/l), Median (IQR); E: baseline CRP level (mg/l), Median (IQR); F: initial GFR level (ml/min), Median (IQR). Abbreviations: VT: ventricular tachycardia, VF: ventricular fibrillation, CRP: C-reactive protein, GFR: glomerular filtration rate, Non-Surv.: “non-survivors”, Surv.: “survivors”. (*p < 0.05, ***p < 0.001).

Fig. 2

Comparative analysis of the predictive power of the EPOS model and the rCAST score. Panel A shows ROC curves for survival comparing the EPOS model (blue curve, AUC 0.86 [95% CI 0.82–0.89]) with the rCAST score (red curve, AUC 0.76 [95% CI 0.72–0.81]). Panel B shows ROC curves for neurological outcomes of the EPOS model (blue curve, AUC 0.84 [95% CI 0.80–0.88] vs. the rCAST score (red curve, AUC 0.76 [95% CI 0.72–0.81]). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)