Accuracy of etiological classification of out-of-hospital cardiac arrest: A scoping review

Sedigheh Shaeri; Julie Considine; Katie N Dainty; Theresa Mariero Olasveengen; Laurie J Morrison

doi:10.1016/j.resuscitation.2024.110199

Accuracy of etiological classification of out-of-hospital cardiac arrest: A scoping review

Resuscitation. 2024 May:198:110199. doi: 10.1016/j.resuscitation.2024.110199. Epub 2024 Apr 4.

Authors

Sedigheh Shaeri¹, Julie Considine², Katie N Dainty³, Theresa Mariero Olasveengen⁴, Laurie J Morrison⁵

Affiliations

¹ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Electronic address: sedigheh.shaeri@mail.utoronto.ca.
² School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research - Eastern Health, Eastern Health, Box Hill, Australia.
³ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Office of Research & Innovation, North York General Hospital, Toronto, Canada.
⁴ Department of Anesthesia and Intensive Care, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁵ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Canada; The Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: laurie.morrison@sunnybrook.ca.

PMID: 38582438
DOI: 10.1016/j.resuscitation.2024.110199

Abstract

Introduction: The Utstein reporting template classifies the etiology of OHCA into "presumed cardiac" and "obvious non-cardiac" or "medical" and "non-medical" categories; however, the accuracy of these classifications is unclear. Ascertaining more accurately the etiology of OHCA is important to tailor advanced life support and identify etiologically consistent patient cohorts for reporting incidence and outcome and enrollment in clinical trials. This scoping review was proposed to identify the state of agreement on etiological classification based on emergency medical service (EMS) data using the Utstein format against other sources.

Method: We searched Medline, EBM-Cochrane, and Embase databases from 1946-2023 to identify studies that reported initial and confirmed etiologies of OHCA. A descriptive review of the included studies was conducted.

Result: The search yielded 22,994 citations. After excluding duplicates, 16,932 citations were reviewed for titles and abstracts. Twelve studies met the inclusion criteria of this review. The frequency of presumed cardiac etiologies based on EMS data was higher than confirmed cardiac etiologies (88% vs 33%) with 83-94% sensitivity and 73-76% specificity. In contrast, the frequency of presumed non-cardiac etiologies was lower than confirmed non-cardiac etiologies (3% vs 27%) with 52-74% sensitivity and 90-97.7% specificity estimated for respiratory disease.

Conclusion: Major disparities exist between current etiological classifications based on the Utstein reporting template and robust sources such as autopsy and medical records. Data linkage and validation are necessary to confirm the etiology of OHCA. Further research is needed on how this misclassification affects reported incidence and outcomes, and how contributing factors may improve etiological classifications.

Keywords: Emergency medical services; Non-cardiac etiology; Out-of-hospital cardiac arrest; Presumed cardiac etiology.

Publication types

Review

MeSH terms

Cardiopulmonary Resuscitation
Emergency Medical Services*
Humans
Out-of-Hospital Cardiac Arrest* / classification
Out-of-Hospital Cardiac Arrest* / epidemiology
Out-of-Hospital Cardiac Arrest* / etiology