Abstract
BackgroundThe aim of this study was to develop a scoring system for identifying the post-cardiac arrest syndrome (PCAS) patients with a good potential for recovery prior to the initiation of induced therapeutic hypothermia.MethodsA multi-center, retrospective, observational study was performed. Data of a total of 151 consecutive adults who underwent induced hypothermia after cardiac arrest (77 learning cases from two hospitals and 74 validation cases from two other hospitals) were analyzed.ResultsIn the learning set, 8 factors (initial rhythm, witnessed status and time until return of spontaneous circulation, pH, serum lactate, motor score according to the Glasgow Coma Scale (GCS), gray matter attenuation to white matter attenuation ratio (GWR), serum albumin, and hemoglobin) were found to be strongly correlated with the neurological outcomes. A tentative scoring system was created from the learning data using these factors, and the predictive accuracy (sensitivity and specificity) was evaluated in terms of both internal validation (0.85 and 0.84) and external validation (cutoff 50%: 0.95 and 0.90, 30%: 0.87 and 0.98, 15%: 0.67 and 1.00). Finally, using all the data, we established a post-Cardiac Arrest Syndrome for induced Therapeutic hypothermia (CAST) score to predict the neurologic prognosis prior to initiation of induced hypothermia.ConclusionsThe CAST score was developed to predict the neurological outcomes of PCAS patients treated by induced hypothermia. The likelihood of good recovery at 30 days was extremely low in PCAS patients with a CAST score of ≤15%. Prospective validation of the score is needed in the future.
Highlights
The aim of this study was to develop a scoring system for identifying the post-cardiac arrest syndrome (PCAS) patients with a good potential for recovery prior to the initiation of induced therapeutic hypothermia
We retrospectively reviewed the clinical management charts of the eligible patients who were admitted to our hospitals during a period spanning the last 3-5 years: 54 patients treated at Nagoya University Hospital between April 2011 and March 2016, 23 patients treated at Chutouen General Medical Center between April 2013 and March 2016, 64 patients treated at Japan Red Cross Maebashi Hospital between April 2011 and March 2016, and 10 patients treated at Komaki City General Hospital between April 2012 and March 2016
Eligible patients were all who were treated with induced hypothermia after experiencing cardiac arrest (induced hypothermia was considered for cardiac arrest patients who were in a coma (GCS ≤ 8) after return of spontaneous circulation (ROSC) without remarkable hemodynamic instability or a “Do Not Attempt to Resuscitation” directive.)
Summary
The aim of this study was to develop a scoring system for identifying the post-cardiac arrest syndrome (PCAS) patients with a good potential for recovery prior to the initiation of induced therapeutic hypothermia. Other studies have revealed correlations between the pH [10], serum lactate [11, 12] and Glasgow Coma Scale (GCS) score [13, 14] with the neurological prognosis in PCAS patients None of these factors has been found to be by itself capable of satisfactorily separating patients with a good outcome from those with a poor outcome, suggesting that establishment of a “suitable scale” based on a combination of prognostic factors might be useful [15, 16]. A summary of this study was previously reported in a letter format [17]
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