Background:
To guide extracorporeal cardiopulmonary resuscitation (eCPR) use, a generalizable survival prediction model is needed.
Methods:
We identified patients≥18 years with IHCA who received eCPR (January 2000-December 2017) in the AHA Get With The Guidelines—Resuscitation registry to build a survival model. We categorized admission CPC into ‘good’ (CPC 1) vs other. We singly imputed variables with ≥15% missing (admission CPC [20%], duration of event [15%]). Variables associated with death (p-value ≤0.1) were retained and initial rhythm was forced into the model. We used firth penalized logistic regression to estimate model parameters. To test the imputation effect, we performed a sensitivity analysis excluding CPC. We performed a Kaplan Meier survival analysis stratified by resuscitation duration (0 to ≤15, 15 to ≤30, 30 to ≤60, ≥60 min).
Results:
Of 1,082 patients who underwent eCPR, 963 were included in the model (
Table 1
). Area Under the Receiving Operating Characteristic (AUROC) = 0.81 (95% CI [0.78 to 0.83]). Associations with death included: nighttime eCPR use; non-white race; patients with prior renal insufficiency, preceding hypoperfusion, and congestive heart failure. Initial rhythm was not associated with death. Every 10 minutes of resuscitation was associated with 12% increased odds of death. Shorter resuscitation duration was strongly associated with hospital survival (
Figure 1
). The AUROC was unchanged (0.81 [95% CI 0.78 - 0.84]) after sensitivity analysis excluding CPC.
Conclusions:
In this preliminary registry analysis, survival after eCPR for IHCA was estimated by patient and arrest characteristics. Our findings require validation.
Tailored Prediction Model of Survival after Liver Transplantation for Hepatocellular Carcinoma
