STUDY OBJECTIVE Asystole is the most common initial rhythm in out-of-hospital cardiac arrest (OHCA) but indicates a low likelihood of neurologic recovery. This study aimed to develop a novel scoring system to be easily applied at the time of emergency department arrival for identifying favorable neurologic outcomes in OHCA survivors with an asystole rhythm. METHODS This study is a secondary analysis based on a previously collected nationwide database, targeting nontraumatic adult OHCA patients aged ≥18 years with an asystole rhythm who achieved return of spontaneous circulation (ROSC) between January 2016 and December 2020. The primary outcome was a favorable neurologic outcome defined as Cerebral Performance Categories scores of 1 or 2 at hospital discharge. A prediction model was developed through multivariable logistic regression analysis in a derivation cohort in the form of a scoring system (WBC-ASystole). The performance and calibration of the model were tested using an internal validation cohort. RESULTS Among 19,803 OHCA patients with survival to hospital admission, 6,322 had asystole, and 285 (4.5%) achieved good neurologic outcomes. Factors associated with favorable outcomes included age, witness arrest, bystander cardiopulmonary resuscitation, time from call to hospital arrival, and out-of-hospital ROSC achievement. The WBC-ASystole score, totaling 11 points, exhibited a predictive performance with an area under the receiver operating characteristic curve of 0.80 (95% confidence interval [CI] 0.76 to 0.83) and 0.79 (95% CI 0.74 to 0.83) in the derivation and validation cohorts, respectively. After categorizing patients into 3 groups based on probability for good neurologic outcomes, the sensitivity and specificity were as follows: 0.98 (95% CI 0.97 to 0.99) and 0.09 (95% CI 0.09 to 0.10) for the very low predicted probability group (WBC-ASystole ≤2), 0.85 (95% CI 0.82 to 0.89) and 0.54 (95% CI 0.53 to 0.55) for the low predicted probability group (WBC-ASystole 3 to 4), and 0.36 (95% CI 0.34 to 0.39) and 0.93 (95% CI 0.92 to 0.93) for fair predicted probability group (WBC-ASystole≥5), respectively. CONCLUSIONS Although external validation studies must be performed, among OHCA patients with asystole, the WBC-ASystole scoring system may identify those patients who are likely to have a favorable neurologic outcome.

中文翻译：

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一个简单的评分系统，用于确定伴有心脏停搏的院外心脏骤停患者的良好神经系统结局。


研究目的 心脏停搏是院外心脏骤停 （OHCA） 中最常见的初始节律，但表明神经功能恢复的可能性较低。本研究旨在开发一种新的评分系统，该系统可在急诊科到达时轻松应用，用于识别心搏停律的 OHCA 幸存者的良好神经系统结果。方法 本研究是基于先前收集的全国数据库的二次分析，针对 2016 年 1 月至 2020 年 12 月期间实现自主循环恢复 （ROSC） 的 ≥18 岁、心搏停止的非创伤成年 OHCA 患者。主要结局是良好的神经系统结局，定义为出院时脑功能类别评分为 1 或 2。通过衍生队列中的多变量 logistic 回归分析以评分系统 （WBC-ASystole） 的形式开发了预测模型。使用内部验证队列测试模型的性能和校准。结果 在 19,803 例存活至入院的 OHCA 患者中，6,322 例出现心脏停搏，285 例 （4.5%） 获得良好的神经系统结局。与良好结局相关的因素包括年龄、证人逮捕、旁观者心肺复苏、从呼叫到医院到达的时间以及院外 ROSC 成就。WBC-ASystole 评分共 11 分，在推导和验证队列中，受试者工作特征曲线下面积分别为 0.80 （95% 置信区间 [CI] 0.76 至 0.83） 和 0.79 （95% CI 0.74 至 0.83）。根据良好神经系统结局的概率将患者分为 3 组后，敏感性和特异性如下： 0.98 （95% CI 0.97 至 0.99） 和 0.09 （95% CI 0.09 至 0.10） 对于极低预测概率组 （WBC-ASystole ≤2），0.85 （95% CI 0.82 至 0.89） 和 0.54 （95% CI 0.53 至 0.55） 对于低预测概率组 （WBC-ASystole 3 至 4），以及 0.36 （95% CI 0.34 至 0.39） 和 0.93 （95% CI 0.92 至 0.93） 对于公平预测概率组 （WBC-ASystole≥5）， 分别。结论 虽然必须进行外部验证研究，但在 OHCA 心脏停搏患者中，WBC-ASystole 评分系统可能会识别出那些可能获得良好神经系统结局的患者。