Resuscitation Using ECPR During In-Hospital Cardiac Arrest (RESCUE-IHCA) Mortality Prediction Score and External Validation

Abstract Background: Futile resuscitation for out-of-hospital cardiac arrest (OHCA) patients in the coronavirus disease (COVID)-19 era can lead to risk of disease transmission and unnecessary transport. Various existing basic or advanced life support (BLS or ALS, respectively) rules for the termination of resuscitation (TOR) have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era.Methods: This was a multicenter observational study using the WinCOVID-19 Daegu registry data collected during February 18–March 31, 2020. The subjects were patients who showed cardiac arrest of presumed cardiac etiology. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity, specificity, false positive value (FPV), and positive predictive value (PPV) of each TOR rule were evaluated. Results: In total, 170 of the 184 OHCA patients were eligible and evaluated. TOR was recommended for 122 patients based on the international basic life support termination of resuscitation (BLS-TOR) rule, which showed 85% specificity, 74% sensitivity, 0.8% FPV, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPV (upper limit of 95% confidence interval <5%), specificity (100%), and PPV (>99%) criteria, only the KoCARC TOR rule I, which included a combination of three factors including not being witnessed by emergency medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock delivery or return of spontaneous circulation, was found to be superior to all other TOR rules. Conclusion: Among the previous nine BLS and ALS TOR rules, KoCARC TOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide.

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Development and External Validation of an Early Prognostic Model for Survivors of Out-of-hospital Cardiac Arrest

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2018.05.022 ◽

2019 ◽

Vol 72 (7) ◽

pp. 535-542

Author(s):

Alberto Pérez-Castellanos ◽

Manuel Martínez-Sellés ◽

Aitor Uribarri ◽

Carolina Devesa-Cordero ◽

José Carlos Sánchez-Salado ◽

...

Keyword(s):

Cardiac Arrest ◽

Prognostic Model ◽

External Validation ◽

Hospital Cardiac Arrest

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External validation of simplified out-of-hospital cardiac arrest and cardiac arrest hospital prognosis scores in a Japanese population: A multicentre retrospective cohort study

10.21203/rs.2.20595/v1 ◽

2020 ◽

Author(s):

Keita Shibahashi ◽

Kazuhiro Sugiyama ◽

Yusuke Kuwahara ◽

Takuto Ishida ◽

Atsushi Sakurai ◽

...

Keyword(s):

Cardiac Arrest ◽

Japanese Population ◽

Goodness Of Fit ◽

External Validation ◽

Predictive Score ◽

Calibration Plot ◽

Goodness Of Fit Test ◽

Neurological Outcomes ◽

Lemeshow Test ◽

Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a global medical problem. The newly-developed simplified out-of-hospital cardiac arrest (sOHCA) and cardiac arrest hospital prognosis (sCAHP) scores used for prognostication of patients admitted alive have not been validated externally. This study was, thus, conducted to externally validate sOHCA and sCAHP scores in a Japanese population. Methods Adult patients resuscitated and admitted to hospitals after intrinsic OHCA (n=2,428, age ≥18 years) were selected from a prospectively collected Japanese database (January 2012–March 2013). We validated sOHCA and sCAHP scores with reference to the original ones in predicting 1-month unfavourable neurological outcomes based on discrimination and calibration measures. Discrimination and calibration were assessed using area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit test with calibration plot, respectively. Results One-month unfavourable neurological outcome was observed in 82% of patients. Score availability was significantly higher in the simplified scores than in the original ones and was highest in the sCAHP score (76%). The AUCs of simplified scores were not significantly different from those of original ones, whereas the AUC of the sCAHP score was significantly higher than that of the sOHCA score (0.88 vs. 0.81, P <0.001). Goodness-of-fit was poor in the sOHCA score (ν= 8, χ 2 =19.1, Hosmer-Lemeshow test: P =0.014) but not in the sCAHP score (ν= 8, χ 2 =13.5, Hosmer-Lemeshow test: P =0.10). Conclusion Performance of original and simplified OHCA and CAHP scores in predicting neurological outcomes in successfully resuscitated OHCA patients were acceptable. Based on the highest availability, similar discrimination, and good calibration, the sCAHP score was the better candidate for clinical implementation. The validated predictive score can help patients’ families, healthcare providers, and researchers by accurately stratifying patients.

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External validation of simplified out-of-hospital cardiac arrest and cardiac arrest hospital prognosis scores in a Japanese population: a multicentre retrospective cohort study

Emergency Medicine Journal ◽

10.1136/emermed-2020-210103 ◽

2021 ◽

pp. emermed-2020-210103

Author(s):

Keita Shibahashi ◽

Kazuhiro Sugiyama ◽

Yusuke Kuwahara ◽

Takuto Ishida ◽

Atsushi Sakurai ◽

...

Keyword(s):

Cardiac Arrest ◽

Japanese Population ◽

Goodness Of Fit ◽

External Validation ◽

Calibration Plot ◽

Goodness Of Fit Test ◽

Neurological Outcomes ◽

Hospitalised Patients ◽

Lemeshow Test ◽

Hospital Cardiac Arrest

BackgroundThe novel simplified out-of-hospital cardiac arrest (sOHCA) and simplified cardiac arrest hospital prognosis (sCAHP) scores used for prognostication of hospitalised patients have not been externally validated. Therefore, this study aimed to externally validate the sOHCA and sCAHP scores in a Japanese population.MethodsWe retrospectively analysed data from a prospectively maintained Japanese database (January 2012 to March 2013). We identified adult patients who had been resuscitated and hospitalised after intrinsic out-of-hospital cardiac arrest (OHCA) (n=2428, age ≥18 years). We validated the sOHCA and sCAHP scores with reference to the original scores in predicting 1-month unfavourable neurological outcomes (cerebral performance categories 3–5) based on the discrimination and calibration measures of area under the receiver operating characteristic curves (AUCs) and a Hosmer-Lemeshow goodness-of-fit test with a calibration plot, respectively.ResultsIn total, 1985/2484 (82%) patients had a 1-month unfavourable neurological outcome. The original OHCA, sOHCA, original cardiac arrest hospital prognosis (CAHP) and sCAHP scores were available for 855/2428 (35%), 1359/2428 (56%), 1130/2428 (47%) and 1834/2428 (76%) patients, respectively. The AUCs of simplified scores did not differ significantly from those of the original scores, whereas the AUC of the sCAHP score was significantly higher than that of the sOHCA score (0.88 vs 0.81, p<0.001). The goodness of fit was poor in the sOHCA score (ν=8, χ2=19.1 and Hosmer-Lemeshow test: p=0.014) but not in the sCAHP score (ν=8, χ2=13.5 and Hosmer-Lemeshow test: p=0.10).ConclusionThe performances of the original and simplified OHCA and CAHP scores in predicting neurological outcomes in successfully resuscitated OHCA patients were acceptable. With the highest availability, similar discrimination and good calibration, the sCAHP score has promising potential for clinical implementation, although further validation studies to evaluate its clinical acceptance are necessary.

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Derivation and Internal Validation of a Mortality Prediction Tool for Initial Survivors of Pediatric In-Hospital Cardiac Arrest*

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000001416 ◽

2018 ◽

Vol 19 (3) ◽

pp. 186-195 ◽

Cited By ~ 11

Author(s):

Mathias J. Holmberg ◽

Ari Moskowitz ◽

Tia T. Raymond ◽

Robert A. Berg ◽

Vinay M. Nadkarni ◽

...

Keyword(s):

Cardiac Arrest ◽

Mortality Prediction ◽

Prediction Tool ◽

Internal Validation ◽

Hospital Cardiac Arrest

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External Validation of the Simple NULL-PLEASE Clinical Score in Predicting Outcome of Out-of-Hospital Cardiac Arrest

The American Journal of Medicine ◽

10.1016/j.amjmed.2017.05.035 ◽

2017 ◽

Vol 130 (12) ◽

pp. 1464.e13-1464.e21 ◽

Cited By ~ 9

Author(s):

Tatjana S. Potpara ◽

Miroslav Mihajlovic ◽

Sanja Stankovic ◽

Tanja Jozic ◽

Irena Jozic ◽

...

Keyword(s):

Cardiac Arrest ◽

External Validation ◽

Clinical Score ◽

Predicting Outcome ◽

Hospital Cardiac Arrest

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Abstract 291: Galectin-3 as a Risk Predictor of Short-Term Mortality in the Resuscitated Cohorts of Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.291 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Zaid Al Jebaje ◽

Umesh C Sharma ◽

Wassim Mosleh ◽

Milind Chaudhari

Keyword(s):

Cardiac Arrest ◽

Multivariate Logistic Regression Analysis ◽

Area Under The Curve ◽

Serum Levels ◽

Mortality Prediction ◽

First Episode ◽

Characteristic Analysis ◽

Shockable Rhythm ◽

Galectin 3 ◽

Hospital Cardiac Arrest

Introduction: Out of Hospital Cardiac Arrest (OHCA) is a common and catastrophic manifestation of multiple cardiac and non-cardiac illnesses. Recent studies showed increase in survival rate, reaching to about one third of those who suffer a bystander witnessed OHCA with a shockable rhythm; yet biomarkers to predict outcomes in this group is still missing. Hypothesis: We tested the hypothesis that serum galectin-3, alone or together with galectin-3 binding protein (G3BP),brain natriuretic peptide (BNP) and troponin, can predict the risk of early (30-day) mortality in ResCOHS. Methods: ResCOHS prospective multicenter pilot study enrolled 117 patients with aborted out-of-hospital cardiac arrest, and 10 healthy volunteers. Transthoracic Echocardiogram was performed for cardiac morphology and function. Serum levels of galectin-3, G3BP, BNP and peak troponin were analyzed. Patients were prospectively followed up for 30-days to determine all-cause in-hospital mortality. Results: Among the ResCOHS, patients who died within 30-days had higher BNP and galectin-3 levels, with no differences in the G3BP, peak troponin, CK and CK-MB levels. Receiver operating characteristic analysis for mortality prediction showed that, for 30-day prognosis, galectin-3 had the greatest area under the curve (AUC) at 0.764 (p = 0.001), whereas G3BP, BNP and troponin had an AUC of 0.518 (p = 0.735), 0.759 (p = 0.001)and 0.540 (p=0.460) respectively. In a multivariate logistic regression analysis, an elevated level of galectin-3 was the strongest independent predictor of 30-day mortality (odds ratio 1.04, p = 0.002). The Kaplan-Meier analyses showed that the combination of an elevated galectin-3 with NT-proBNP was a better predictor of mortality than either of the 2 markers alone. Conclusions: In the ResCOHS, higher serum galectin-3 levels are associated with increased chances of death within 30-days of the first episode of cardiac arrest. These findings have implications to target specific therapies to those at the greatest risk of mortality after OHCA.

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LO16: Predicting survival from out-of-hospital cardiac arrest

CJEM ◽

10.1017/cem.2020.72 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S12-S13

Author(s):

I. Drennan ◽

K. Thorpe ◽

S. Cheskes ◽

M. Mamdani ◽

D. Scales ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

External Validation ◽

Predictive Performance ◽

Roc Curves ◽

High Rate ◽

Future Research ◽

Good Neurological Outcome ◽

Do Not Resuscitate ◽

Hospital Cardiac Arrest

Introduction: Prognostication is a significant challenge early in the post-cardiac arrest period. Common prognostic factors for neurological survival are unreliable (high false positive rates) until 72 hours post-cardiac arrest. It is not known whether there are a combination of factors that can be utilized earlier in the post-cardiac arrest period to accurately predict patient outcome. Our objective was to predict neurological outcome utilizing a novel combination of patient factors early in the post-cardiac arrest period. Methods: We conducted a retrospective cohort study using data from our local cardiac arrest registry. We included adult patients who obtained a return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). We excluded patients who did not survive for at least 24 hours post-ROSC and those who had a do not resuscitate (DNR) order within 2 hours of ROSC. We performed an ordinal regression analysis using the proportional odds model to predict neurological outcome (modified rankin score (mRS)). We included a good neurological outcome (mRS 0-2), poor neurological outcome (mRS 3-5), and dead (mRS 6) as an ordinal outcome. We included a number of patient demographics, intra- and post-cardiac arrest factors as covariates in our model. The predictive performance of our model was analyzed using receiver operating characteristic (ROC) curves for discrimination and Brier statistic for calibration. Results: We included 3448 patients in our analysis. We found that an initial shockable rhythm (odds ratio (OR) 4.1; 95% confidence interval (CI) 3.6, 5.4), the absence of pupillary reflexes (OR 3.5; 95% CI 2.4,4.8) and maximum motor score on the Glasgow Coma Scale (GCS) (OR 1.5; 95% CI 1.4,1.6) had the greatest association with improved neurologic outcome. Longer duration of resuscitation was associate with worse outcomes (OR 0.84, 95% CI 0.82,0.87). The overall performance of our model was excellent with an area under the ROC curve of 0.89 and a Brier statistic of 0.13. Conclusion: Our model predicted good neurological outcome with a high rate of accuracy, however external validation of the model is required. This model may be useful in providing initial risk stratification of patients in clinical practice and future research on post-cardiac arrest care.

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