Is the Cerebral Performance Category Score a Valid Measure of Functional Outcome after Out-of-hospital Cardiac Arrest?

2005 ◽  
Vol 12 (Supplement 1) ◽  
pp. 71-71 ◽  
Author(s):  
L. P. Nesbitt
Keyword(s):  
Cardiac Arrest ◽  
Functional Outcome ◽  
Cerebral Performance Category ◽  
Valid Measure ◽  
Performance Category ◽  
Cerebral Performance Category Score ◽  
Hospital Cardiac Arrest ◽  
Category Score

scholarly journals Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Konrad Kirsch ◽  
Stefan Heymel ◽  
Albrecht Günther ◽  
Kathleen Vahl ◽  
Thorsten Schmidt ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
White Matter ◽  
Circulatory Arrest ◽  
Cerebral Performance Category ◽  
Time Interval ◽  
Performance Category ◽  
Neurologic Outcomes ◽  
Ischaemic Brain ◽  
Cerebral Performance Category Score ◽  
Category Score

Abstract Background This study aimed to assess the prognostic value regarding neurologic outcome of CT neuroimaging based Gray-White-Matter-Ratio measurement in patients after resuscitation from cardiac arrest. Methods We retrospectively evaluated CT neuroimaging studies of 91 comatose patients resuscitated from cardiac arrest and 46 non-comatose controls. We tested the diagnostic performance of Gray-White-Matter-Ratio compared with established morphologic signs of hypoxic-ischaemic brain injury, e. g. loss of distinction between gray and white matter, and laboratory parameters, i. e. neuron-specific enolase, for the prediction of poor neurologic outcomes after resuscitated cardiac arrest. Primary endpoint was neurologic function assessed with cerebral performance category score 30 days after the index event. Results Gray-White-Matter-Ratio showed encouraging interobserver variability (ICC 0.670 [95% CI: 0.592–0.741] compared to assessment of established morphologic signs of hypoxic-ischaemic brain injury (Fleiss kappa 0.389 [95% CI: 0.320–0.457]) in CT neuroimaging studies. It correlated with cerebral performance category score with lower Gray-White-Matter-Ratios associated with unfavourable neurologic outcomes. A cut-off of 1.17 derived from the control population predicted unfavourable neurologic outcomes in adult survivors of cardiac arrest with 100% specificity, 50.3% sensitivity, 100% positive predictive value, and 39.3% negative predictive value. Gray-White-Matter-Ratio prognostic power depended on the time interval between circulatory arrest and CT imaging, with increasing sensitivity the later the image acquisition was executed. Conclusions A reduced Gray-White-Matter-Ratio is a highly specific prognostic marker of poor neurologic outcomes early after resuscitation from cardiac arrest. Sensitivity seems to be dependent on the time interval between circulatory arrest and image acquisition, with limited value within the first 12 h.

Abstract 82: Mechanical CPR Is Associated with Poor Neurologically Intact Survival in a Statewide Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Scott Youngquist ◽  
Patrick Ockerse ◽  
Chris Stratford ◽  
Peter Taillac
Keyword(s):  
Cardiac Arrest ◽  
Randomized Trials ◽  
Cerebral Performance Category ◽  
Comparative Performance ◽  
Performance Category ◽  
Neurologically Intact ◽  
Residual Confounding ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest ◽  
Category Score

BACKGROUND: Large, randomized trials have concluded that mechanical CPR (mech-CPR) is equivalent to manual CPR (man-CPR) with respect to outcomes from out-of-hospital cardiac arrest (OHCA). However, outside of such well-controlled settings, the performance of mech-CPR is uncertain. We sought to determine the association, if any, between mech-CPR use and outcomes in a large, statewide registry of cardiac arrest. METHODS: The Utah State CARES registry began collecting outcomes on all cardiac arrests in the state of Utah in July of 2012. We analyzed data from this registry to determine the comparative performance of resuscitations utilizing mech-CPR vs man-CPR. Neurologically-intact survival was defined as a Cerebral Performance Category score of 1 or 2. RESULTS: Mech-CPR was performed on 237/1,567 OHCAs (15%) during the 1.5 year period of analysis. The majority of devices used were of the load-distributing band type 213/237 (90%). Neurologically-intact survival was 10/237 (4%) in the cohort receiving mech-CPR vs 149/1,330 (11%) in the cohort receiving man-CPR. When controlling for Utstein variables (TABLE), mech-CPR was associated with significantly reduced odds of neurologically-intact survival, with an adjusted odds ratio 0.4 (95% CI 0.2-0.9). CONCLUSIONS: We observed a statistically significant association between mech-CPR use during resuscitation and reduced odds of neurologically-intact survival in our statewide cardiac arrest database. Outside of randomized trials, the resuscitation performance of mech-CPR devices may suffer from poor implementation or increased application to non-viable survivors. Residual confounding of this observational finding is also possible.

scholarly journals Predictors of Functional Outcome after Intraoperative Cardiac Arrest

2014 ◽  
Vol 121 (3) ◽  
pp. 482-491 ◽  
Author(s):  
Anne-Laure Constant ◽  
Claire Montlahuc ◽  
David Grimaldi ◽  
Nicolas Pichon ◽  
Nicolas Mongardon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Ventricular Fibrillation ◽  
Odds Ratio ◽  
Functional Outcomes ◽  
Cerebral Performance Category ◽  
Performance Category ◽  
Cerebral Performance Category Score ◽  
Category Score

Abstract Background: Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA. Methods: Patients admitted to 11 intensive care units in a period of 2000–2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2. Results: Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012). Conclusions: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.

Abstract 240: Are the Same Resuscitation Protocols Needed for Highly Aged Victims With Out-of-Hospital Cardiac Arrest as Middle or Younger Aged?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Hiroyuki Hanada ◽  
Yoshio Tahara ◽  
Satoshi Yasuda ◽  
Teruo Noguchi ◽  
Kunihiro Nishimura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Total Population ◽  
Cerebral Performance Category ◽  
Population Based ◽  
Aged Patients ◽  
Performance Category ◽  
Aging Society ◽  
Shockable Rhythm ◽  
Activity Of Daily Life ◽  
Hospital Cardiac Arrest

Backgrounds: The population of elderly people aged 65 years or older in 2014 is 33 million, and the aging rate (proportion of the total population) is 26.0% in Japan. Victims facing to out of hospital cardiac arrest (OHCA) are getting older and older. Emergency medical system (EMS) in Japan must do the same resuscitation protocols once called to the patient with OHCA, even when he or she is very old and activity of daily life is very low. We need to clarify whether same resuscitation protocols are required to very highly aged patients with OHCA or not. Methods and Results: From January 2005 through December 2014, we conducted a prospective, population-based, observational study involving the consecutive patients across Japan who had OHCA (n= 1,299,784). The percentage of patients with OHCA aged more than 80 years old was increasing from 37.1% in 2005 to 47.8% in 2014 by 1% each year. Survival at one month after OHCA with cerebral performance category (CPC) scale 1 or 2 were 4,368 out of total 318,590 OHCA (1.4%) in 80’s, 1043 out of 126,546 (0.8%) in 90’s, and 35 out of 5,544 (0.6%) in aged more than 100 (from 100 to 114). Survival at one month after OHCA with CPC scale 1 or 2 was 11.084 out of 234,366 (4.7%) in 50- 60’s. Patients with witnessed OHCA with shockable rhythm and by-stander CPR survived to CPC 1 or 2 at one month after OHCA were 8.0% in 80’s, 4.1% in 90’s, 0 in aged more than 100, and 22.2% in 50-60’s respectably. Conclusion: Number of survivors with CPC 1 or 2 were very few in patients with OHCA aged more than 80 years old, but still existed. Although the same resuscitation protocols are needed for highly aged victims with OHCA, another system which arrow EMS to stop resuscitation should be established in the highly aging society.

The incidence of postoperative hyponatremia and associated neurological sequelae in children with intracranial neoplasms

2014 ◽  
Vol 13 (3) ◽  
pp. 283-290 ◽  
Author(s):  
Cydni N. Williams ◽  
Jennifer S. Belzer ◽  
Jay Riva-Cambrin ◽  
Angela P. Presson ◽  
Susan L. Bratton
Keyword(s):  
Obstructive Hydrocephalus ◽  
Cerebral Performance Category ◽  
Young Age ◽  
Neurosurgical Procedures ◽  
Intracranial Tumors ◽  
Performance Category ◽  
Increased Risk ◽  
Neurosurgical Patients ◽  
Cerebral Performance Category Score ◽  
Category Score

Object Intracranial tumors are common pediatric neoplasms and account for substantial morbidity among children with cancer. Hyponatremia is a known complication of neurosurgical procedures and is associated with higher morbidity among neurosurgical patients. The authors aimed to estimate the incidence of hyponatremia, identify clinical characteristics associated with hyponatremia, and assess the association between hyponatremia and patient outcome among children undergoing surgery for intracranial tumors. Methods This is a retrospective cohort study of children ranging in age from 0 to 19 years who underwent an initial neurosurgical procedure for an intracranial tumor between January 2001 and February 2012. Hyponatremia was defined as serum sodium ≤ 130 mEq/L during admission. Results Hyponatremia during admission occurred in 39 (12%) of 319 patients and was associated with young age and obstructive hydrocephalus (relative risk [RR] 2.9 [95% CI 1.3–6.3]). Hyponatremic patients were frequently symptomatic; 21% had seizures and 41% had altered mental status. Hyponatremia was associated with complicated care including mechanical ventilation (RR 4.4 [95% CI 2.5–7.9]), physical therapy (RR 4 [95% CI 1.8–8.8]), supplemental nutrition (RR 5.7 [95% CI 3.3–9.8]), and infection (RR 5.7 [95% CI 3.3–9.5]). Hyponatremic patients had a 5-fold increased risk of moderate or severe disability on the basis of their Pediatric Cerebral Performance Category score at discharge (RR 5.3 [95% CI 2.9–9.8]). Obstructive hydrocephalus (adjusted odds ratio [aOR] 3.24 [95% CI 1.38–8.94]) and young age (aOR 0.92 [95% CI 0.85–0.99]) were independently associated with hyponatremia during admission. Hyponatremia was independently associated with moderate or worse disability by Pediatric Cerebral Performance Category score at discharge (aOR 6.2 [95% CI 3.0–13.03]). Conclusions Hyponatremia was common, particularly among younger children and those with hydrocephalus. Hyponatremia was frequently symptomatic and was associated with more complicated hospital courses. Hyponatremia was independently associated with worse neurological outcome when adjusted for age and tumor factors. This study serves as an exploratory analysis identifying important risk factors for hyponatremia and associated sequelae. Further research into the causes of hyponatremia and the association with poor outcome is needed to determine if prevention and treatment of hyponatremia can improve outcomes in these children.

Abstract 218: Novel Blood Biomarker Taurine and Glutamate for Early Predicting Outcomes After Out-of-hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jing Li ◽  
Kevin Qin ◽  
Pratik B Doshi ◽  
Xiangdong Zhu ◽  
Pavitra Kotini-Shah ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Hospital Arrival ◽  
Performance Category ◽  
Time Points ◽  
Critical Elements ◽  
Glutamate Concentration ◽  
Blood Biomarker ◽  
Hospital Cardiac Arrest ◽  
Over Time

Introduction: Out-of-Hospital cardiac arrest (OHCA) is the leading cause of death with an overall survival rate of less than 10%. Organ failure and metabolic impairment are two critical elements of post-CA syndrome. Taurine and glutamate are amino acids that are expressed primarily in heart and brain. The compensatory release during osmotic stress, as seen in CA, amplifies reperfusion injury, heart stunning and brain edema. Thus, taurine and glutamate concentrations in blood likely reflects the extent of injury in the heart and brain following CA. Hypothesis: Plasma taurine and glutamate concentration correlates with CA outcomes. Methods: Adult OHCA patients (n=37) at an urban academic ED were enrolled from 2018-2019. Among them, 14 were survivors (S) and 23 were nonsurvivors (NS). Blood samples were collected at various time points including the time at hospital arrival, 6, 24, 48, 72 hours after arrival (T0, 6, 24, 48 and 72 h, respectively), and measured. T-test and GEE were used for mean comparison and longitudinal trend analysis, respectively. p < 0.05 was considered as statistically significant. Results: Plasma taurine and glutamate concentrations were compared between S and NS at T0 and across all time points. Both concentrations were significantly higher in NS vs S group at T0 (for taurine: 77.7 ± 40.0 in NS vs. 60.0 ± 31.9 μM in S, p =0.014; for glutamate: 176.4 ± 98.7 in NS vs. 162.8 ± 111.1 μM in S, p =0.0496), and showed a decreasing trend over time. In the first 6 h, taurine and glutamate level decreased more in S group than NS group (over 30% drop in S compared to <15% drop in NS). In addition, a positive correlation of cerebral performance category was seen at T6 with taurine (p=0.0354), but not with glutamate. Conclusions: Blood taurine and glutamate may serve as early biomarkers in predicting OHCA outcomes. Monitoring their change over time can help physicians tailor treatment decisions and patient management.

scholarly journals Post-resuscitation partial pressure of arterial carbon dioxide and outcome in patients with out-of-hospital cardiac arrest: a multicenter retrospective cohort study

2021 ◽  
Author(s):  
Nobunaga Okada ◽  
Tasuku Matsuyama ◽  
Yohei Okada ◽  
Asami Okada ◽  
Kenji Kandori ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Multivariate Logistic Regression Analysis ◽  
Spontaneous Circulation ◽  
Performance Category ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest

Abstract We aimed to estimate the association between PaCO2 level in the patient after out-of-hospital cardiac arrest (OHCA) resuscitation with patient outcome based on a multicenter prospective cohort registry in Japan between June 2014 and December 2015.Based on the PaCO2 within 24-h after return of spontaneous circulation (ROSC), patients were divided into six groups as follow; severe hypocapnia (<25mmHg), mild hypocapnia (25–35mmHg,), normocapnia (35–45mmHg), mild hypercapnia (45–55mmHg), severe hypercapnia (>55mmHg), exposure to both hypocapnia and hypercapnia. Multivariate logistic regression analysis was conducted to calculate the adjusted odds ratios (aORs) and 95% confidence interval (CI) for the 1-month poor neurological outcome (Cerebral Performance Category ≥3). Among the 13491 OHCA patients, 607 were included. Severe hypocapnia, mild hypocapnia, severe hypercapnia, and exposure to both hypocapnia and hypercapnia were associated with a higher rate of 1-month poor neurological outcome compared with mild hypercapnia (aOR 6.68 [95% CI 2.16–20.67], 2.56 [1.30–5.04], 2.62 [1.06–6.47], 5.63 [2.21–14.34]; respectively). There was no significant difference between the outcome of patients with normocapnia and mild hypercapnia. In conclusion, maintaining normocapnia and mild hypercapnia during the 24-h after ROSC was associated with better neurological outcomes than other PaCO2 abnormalities in this study.

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