ArticleAnnals of medicine2026
Influencing factors analysis and prediction model development for ROSC in adult non-traumatic OHCA: a retrospective study based on pre-hospital emergency settings.
Article in Annals of medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCardiac arrest is a major global public health problem. This study aimed to explore factors influencing return of spontaneous circulation (ROSC) and develop a prediction model for out-of-hospital cardiac arrest (OHCA) patients.
methodsWe retrospectively collected electronic medical records of adult non-traumatic OHCA patients at Tianjin Emergency Medical Center from January 1, 2023 to December 31, 2024. The primary outcome was sustained ROSC up to emergency department arrival and handover to receiving-hospital staff. Multivariable mixed-effects logistic regression with clinician ID as random intercept adjusted clustering bias; predictors with
resultsAmong 9,386 included cases, 678 (7.2%) achieved ROSC. Mixed-effects regression identified independent ROSC predictors: public location (aOR = 1.285, 95% CI:1.038-1.592), 06:00-12:00 onset (aOR = 1.308, 95% CI:1.018-1.682), prolonged emergency response time (aOR = 0.971, 95% CI:0.945-0.999), extended onset-to-ambulance intervals (5-10 min: aOR = 0.758;10-30 min: aOR = 0.578;>30 min:aOR = 0.498 vs ≤5 min), no OHCA occurred at emergency call (aOR = 1.540, 95% CI:1.048-2.262), male attending physicians (aOR = 1.255, 95% CI:1.077-1.464), longer physician practice years (aOR = 1.043, 95%CI: 1.022-1.065), intermediate physician title (aOR = 1.236, 95% CI:1.047-1.459), shockable initial rhythm (aOR = 2.850, 95% CI:2.390-3.397), endotracheal intubation (aOR = 2.294, 95% CI:1.936-2.718), epinephrine >5 mg (aOR = 0.765,95% CI:0.626-0.935). The nomogram AUC reached 0.775 (95% CI:0.756-0.794) in the training set and 0.775 (95% CI:0.745-0.805) in the test set; 1000 bootstrap internal validation gave an optimism-corrected C-index of 0.7679 with minimal optimism of 0.0071, showing negligible overfitting, good calibration and favorable net clinical benefit
conclusionThis study identified multiple factors significantly associated with ROSC in OHCA patients; the constructed model showed good predictive value.
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