Prediction of outcome after out-of-hospital cardiac arrest already on hospital admission-not reliable enough to be true!

Abstract

This editorial refers to ‘The CAHP (Cardiac Arrest Hospital Prognosis) score: a tool for risk stratification after out-of-hospital cardiac arrest’[†][1], by C. Maupain et al ., on page 3222. Approximately 275 000 Europeans are resuscitated yearly from out-of-hospital cardiac arrest (OHCA).1 Survival has improved markedly in a number of places around the world in the last 10–15 years due to increased rates of bystander cardiopulmonary resuscitation (CPR), early defibrillation and better quality of post-resuscitation care.2–4 Still, the majority of patients die without ever experiencing return of spontaneous circulation (ROSC). Among those admitted to hospital with ROSC, 50–75% never recover and die, the majority due the neurological injury caused by severe cerebral ischaemia as part of the post–cardiac arrest syndrome.5 Hospital treatment after primary successful resuscitation of OHCA victims is challenging, requires huge resources and involves several different specialised health care personnel, especially during the initial critical phase in the intensive care unit (ICU). Prolonged treatment of comatose patients without hope for successful recovery is meaningless, but the challenge for the clinician is to reliably assess which patients can survive with good neurological outcome after receiving advanced post-resuscitation care and which will not. Withdrawal of life-sustaining therapy (WLST) during the post-resuscitation period is the most frequent cause of death, occurring in ∼50% of the patients.6,7 This WLST policy should be based on reliable prognostication, but this has been most challenging in the last 10–15 years due to uncertainty in prognostication algorithms, especially after the introduction of therapeutic hypothermia/targeted temperature management (TTM).8 There are no prospective studies that have formulated a predictive model giving an acceptable … [1]: #fn-2