scholarly journals Use of SOFA score in cardiac arrest research: A scoping review

2020 ◽  
Vol 4 ◽  
pp. 100040
Author(s):  
Anne V. Grossestreuer ◽  
Tuyen T. Yankama ◽  
Ari Moskowitz ◽  
Long Ngo ◽  
Michael W. Donnino
Keyword(s):  
Cardiac Arrest ◽  
Scoping Review ◽  
Sofa Score

Abstract 316: Missing Data and the SOFA Score in Cardiac Arrest Research: A Scoping Review

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Anne V Grossestreuer ◽  
Tuyen Yankama ◽  
Ari Moskowitz ◽  
Long H Ngo ◽  
Michael Donnino
Keyword(s):  
Cardiac Arrest ◽  
Missing Data ◽  
Scoping Review ◽  
Sofa Score ◽  
English Language ◽  
Primary Outcome ◽  
Vital Signs ◽  
Sensitivity Analyses ◽  
Inclusion Criteria ◽  
Time Points

Introduction: The Sequential Organ Failure Assessment (SOFA) score is often used as an outcome or exposure in cardiac arrest studies. SOFA requires lab values and vital signs at certain time points which often results in missing data. How this missing data is handled is unknown. Methods: We performed a scoping review of PubMed, EMBASE, and Web of Science. English language peer-reviewed manuscripts were included. Titles/abstracts were screened by two independent reviewers to assess if they met inclusion criteria. Studies that met inclusion criteria were retrieved in full; those that did not were excluded. Disagreements between reviewers were resolved by a third reviewer. Results: The initial search provided 408 abstracts, 142 underwent full-text review (kappa: 0.91), and 66 were included (5 randomized controlled trials, 26 prospective and 25 retrospective studies). The studies had a median of 151 (IQR: 55, 278) subjects. SOFA was used as an outcome in 36 (55%) and a primary outcome in 10 (15%). Only 27 (41%) studies reported a method to handle missing SOFA data. The most common method was to exclude subjects with missing data (81%). Other methods were use of maximum SOFA while subjects were alive (11%), modified SOFA after excluding subjects who died prior to the timepoint (11%), and earlier and later SOFA to impute values (4%). When SOFA was the primary outcome, 4 (40%) reported a method; 3 (75%) excluded subjects and one (25%) used modified SOFA. Two studies conducted sensitivity analyses to test assumptions used to handle missing SOFA (one imputed values for death/discharge, one adjusted for mortality difference prior to SOFA measurement). Only 9 studies (14%) mentioned quantity of missing SOFA, ranging from 0-76% (median: 10% [IQR: 6%, 42%]). In the 50 studies using SOFA at time points after baseline, only 11 (22%) mentioned mortality prior to SOFA measurement; when mentioned, it ranged from 3%-76% with a median of 12% (IQR: 6%-35%). Conclusion: Missing data for SOFA scores used in cardiac arrest studies is pervasive yet often not acknowledged and/or handled with described or consistent methods. These findings illustrate that studies using SOFA may exhibit substantial bias and results could be misinterpreted, particularly if patients with missing data are excluded.

Abstract 353: Performance of SOFA Score to Predict Mortality at Hospital Discharge After Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Anne V Grossestreuer ◽  
Tuyen Yankama ◽  
Ari Moskowitz ◽  
Anthony Mahoney-Pacheco ◽  
Varun Konanki ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Sofa Score ◽  
Statistical Power ◽  
Goodness Of Fit ◽  
Outcome Measure ◽  
Model Performance ◽  
Surrogate Outcome ◽  
Surrogate Outcome Measure ◽  
Good Calibration

Introduction: Cardiac arrest (CA) outcomes, when dichotomized as survival/non-survival, limit statistical power of interventional studies and do not acknowledge hospital-level factors independent of post-CA sequelae. We explored the Sequential Organ Failure Assessment (SOFA) score at 72 hours post-CA as a surrogate outcome measure for mortality. We also assessed methods to account for death <72 hours post-CA in SOFA score computation. Methods: This was a single center retrospective study of post-CA patients from 1/08-12/17. SOFA score components were abstracted at baseline, 24, 48, and 72h post-CA. Thirteen ways of accounting for missing data were assessed. The outcome was mortality at hospital discharge. Model performance was assessed using area under the receiver-operator characteristic (AUC) curves and Hosmer-Lemeshow goodness of fit statistics. Results: Of 847 patients, 528 (62%) had complete baseline SOFA scores and 205 (24%) had complete scores at 72h. Death <72h occurred in 28%; 45% survived to hospital discharge. SOFA score at 72h without accounting for death had an AUC of 0.62. The best performing SOFA model at 72h with good calibration imputed a 20% increase over the last observed SOFA score in patients who expired <72h with an AUC of 0.79 (95% CI: 0.74-0.83). In terms of change in SOFA at 72h from baseline, the best performing model with good calibration imputed death <72h as the highest possible score (AUC: 0.88 [95% CI: 0.84-0.92]). These results were consistent when analyzing in- and out-of-hospital CA separately, although the change from baseline model was not well calibrated in in-hospital arrests. Conclusions: Without consideration of death, SOFA scores at 72 hours post-CA perform poorly. Imputing for early mortality improved the model. If this imputation structure is validated prospectively, SOFA could provide a scoring system to predict death at hospital discharge and serve as a surrogate outcome measure in interventional studies.

Artificial Intelligence in Predicting Cardiac Arrest: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Asma Alamgir ◽  
Osama Mousa 2nd ◽  
Zubair Shah 3rd
Keyword(s):  
Artificial Intelligence ◽  
At Risk ◽  
Cardiac Arrest ◽  
Scoping Review ◽  
Pediatric Population ◽  
Data Extraction ◽  
Warning System ◽  
Reference List ◽  
Evaluation Tool ◽  
Patients At Risk

BACKGROUND Cardiac arrest is a life-threatening cessation of heart activity. Early prediction of cardiac arrest is important as it provides an opportunity to take the necessary measures to prevent or intervene during the onset. Artificial intelligence technologies and big data have been increasingly used to enhance the ability to predict and prepare for the patients at risk. OBJECTIVE This study aims to explore the use of AI technology in predicting cardiac arrest as reported in the literature. METHODS Scoping review was conducted in line with guidelines of PRISMA Extension for Scoping Review (PRISMA-ScR). Scopus, Science Direct, Embase, IEEE, and Google Scholar were searched to identify relevant studies. Backward reference list checking of included studies was also conducted. The study selection and data extraction were conducted independently by two reviewers. Data extracted from the included studies were synthesized narratively. RESULTS Out of 697 citations retrieved, 41 studies were included in the review, and 6 were added after backward citation checking. The included studies reported the use of AI in the prediction of cardiac arrest. We were able to classify the approach taken by the studies in three different categories - 26 studies predicted cardiac arrest by analyzing specific parameters or variables of the patients while 16 studies developed an AI-based warning system. The rest of the 5 studies focused on distinguishing high-risk cardiac arrest patients from patients, not at risk. 2 studies focused on the pediatric population, and the rest focused on adults (n=45). The majority of the studies used datasets with a size of less than 10,000 (n=32). Machine learning models were the most prominent branch of AI used in the prediction of cardiac arrest in the studies (n=38) and the most used algorithm belonged to the neural network (n=23). K-Fold cross-validation was the most used algorithm evaluation tool reported in the studies (n=24). CONCLUSIONS : AI is extensively being used to predict cardiac arrest in different patient settings. Technology is expected to play an integral role in changing cardiac medicine for the better. There is a need for more reviews to learn the obstacles of implementing AI technologies in the clinical setting. Moreover, research focusing on how to best provide clinicians support to understand, adapt and implement the technology in their practice is also required.

scholarly journals Perfusion parameters and target values during extracorporeal cardiopulmonary resuscitation: a scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030562
Author(s):  
Lars Saemann ◽  
Christine Schmucker ◽  
Lisa Rösner ◽  
Friedhelm Beyersdorf ◽  
Christoph Benk
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Scoping Review ◽  
Citation Index ◽  
Data Extraction ◽  
Survival Rates ◽  
Social Science Citation Index ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Target Values ◽  
Hospital Cardiac Arrest

IntroductionExtracorporeal cardiopulmonary resuscitation (eCPR) is increasingly applied in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients. Treatment results are promising, but the efficacy and safety of the procedure are still unclear. Currently, there are no recommended target perfusion parameters during eCPR, the lack of which could result in inadequate (re)perfusion. We aim to perform a scoping review to explore the current literature addressing target perfusion parameters, target values, corresponding survival rates and neurologic outcomes in OHCA and IHCA patients treated with eCPR.Methods and analysisTo identify relevant research, we will conduct searches in the electronic databases MEDLINE, EMBASE, Social Science Citation Index, Social Science Citation Index Expanded and the Cochrane library. We will also check references of relevant articles and perform a cited reference research (forward citation tracking).Two independent reviewers will screen titles and abstracts, check full texts for eligibility and perform data extraction. We will resolve dissent by consensus, moderated by a third reviewer. We will include observational and controlled studies addressing target perfusion parameters and outcomes such as survival rates and neurologic findings in OHCA and IHCA patients treated with eCPR. Data extraction tables will be set up, including study and patients’ characteristics, aim of study, details on eCPR including target perfusion parameters and reported outcomes. We will summarise the data using tables and figures (ie, bubble plot) to present the research landscape and to describe potential clusters and/or gaps.Ethics and disseminationAn ethical approval is not needed. We intend to publish the scoping review in a peer-reviewed journal and present results on a scientific meeting.

scholarly journals Use, Outcomes and Policy on the Placement of Automated External Defibrillators on Commercial Aircraft for the Management of In-flight Cardiac Arrest; A Scoping Review

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Patrick Sheehan ◽  
Tom Quinn
Keyword(s):  
Cardiac Arrest ◽  
Scoping Review ◽  
Extraction Methods ◽  
Commercial Aircraft ◽  
Public Places ◽  
Shock Delivery ◽  
Automated External Defibrillators ◽  
Shockable Rhythm ◽  
Online Databases ◽  
International Policies

<p><strong>ABSTRACT</strong></p><p><strong>Introduction </strong></p><p>Automated external defibrillators (AEDs) are increasingly available in public places for the treatment of cardiac arrest. Some commercial aircraft carry an AED, but little is known about international policies and requirements. The aim is to review policy regarding AED placement on commercial aircraft, summarising reported incidence and outcomes of AED utilisation for individuals experiencing an in-flight cardiac arrest (IFCA).</p><p><strong>Methods</strong></p><p>A scoping review was undertaken. Online databases (Medline and CINAHL) were searched using prespecified terms to identify reports evidencing use, outcome and policy of AEDS for IFCA on commercial aircraft. Reports were screened and data extracted following scoping review extraction methods. Data were analysed to describe incidence of AED use and outcomes following IFCA, and policies regarding AED placement on commercial aircraft.</p><p><strong>Results</strong>  </p><p>9 observational studies were identified. 8 reported instances of successful shock delivery using AED. No published reports of safety incidents involving in-flight AED use were found. 7 studies reported survival following AED use: of these, 6 reported administration of a shock for IFCA survivors, whilst 1 study reported deployment of an AED without shock delivery.  Overall, survival following in-flight AED use was 9%, with 37% survival reported where patients presented with shockable rhythm. Only one policy mandating AED placement on commercial aircraft was identified.</p><p><strong>Conclusion</strong></p><p>Despite the small, retrospective and observational nature of the reports identified, findings suggest in-flight AED use is feasible and associated with improved outcomes from IFCA.</p><p><strong>Keywords:</strong> cardiac arrest; defibrillators; AED; aircraft; flight </p>

Sign in / Sign up

Export Citation Format

Share Document