Acute cardiac care & resuscitation
Development and validation of multivariable risk adjustment models for return of spontaneous circulation and survival to hospital discharge following out-of-hospital cardiac arrest in England
Authors' conclusion
These validated models demonstrated strong performance, improved on previous models, and may support benchmarking, audit, and quality improvement initiatives.
Study context
- Population
- Patients with out-of-hospital cardiac arrest (OHCA) in England from 1 January 2016 and 31 December 2017, where resuscitation was attempted by the emergency medical service2016 cohort (development) 27,942 · 2017 cohort (validation) 28,425Events: Return of spontaneous circulation (ROSC) occurred in 28.6% of cases and survival in 8.2%
- Predictors
- Age, sex, witnessed status, aetiology, bystander CPR, initial rhythm, and public access defibrillator use
- Predicted outcome
- ROSC at hospital handover and survival to hospital discharge
Methodological detailsnational registry data, multivariable logistic regression, backward stepwise selection
- National registry data
- Multivariable logistic regression
- Backward stepwise selection
Model performance
As reported in the abstract
AUC
ROSC model, development
0.702(95% CI: 0.694-0.711)
ROSC model, validation
0.712(0.704-0.719)
Survival model, development
0.877(0.868-0.887)
Survival model, validation
0.871(0.862-0.879)
| Test or model | Brier score |
|---|---|
| ROSC model, development | 0.182 |
| ROSC model, validation | 0.182 |
| Survival model, development | 0.059 |
| Survival model, validation | 0.061 |
Brier score
ROSC model, development0.182
ROSC model, validation0.182
Survival model, development0.059
Survival model, validation0.061
Further findings
Predictor selection
- All candidate predictors were retained for ROSC, while sex was excluded from the final survival model
Original publication
Development and validation of multivariable risk adjustment models for return of spontaneous circulation and survival to hospital discharge following out-of-hospital cardiac arrest in England. Eur Heart J Qual Care Clin Outcomes. Published 18 December 2025. doi:10.
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