Abstract
The aim of this study in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM) was to evaluate the prognostic value of OHCA, C-GRApH, and CAHP scores with initial neurologic examinations for predicting neurologic outcomes. This retrospective study included OHCA patients treated with TTM from 2009 to 2017. We calculated three cardiac arrest (CA)-specific risk scores (OHCA, C-GRApH, and CAHP) at the time of admission. The initial neurologic examination included an evaluation of the Full Outline of UnResponsiveness brainstem reflexes (FOUR_B) and Glasgow Coma Scale motor (GCS_M) scores. The primary outcome was the neurologic outcome at hospital discharge. Of 311 subjects, 99 (31.8%) had a good neurologic outcome at hospital discharge. The OHCA score had an area under the receiver operating characteristic curve (AUROC) of 0.844 (95% confidence interval (CI): 0.798-0.884), the C-GRApH score had an AUROC of 0.779 (95% CI: 0.728-0.824), and the CAHP score had an AUROC of 0.872 (95% CI: 0.830-0.907). The addition of the FOUR_B or GCS_M score to the OHCA score improved the prediction of poor neurologic outcome (with FOUR_B: AUROC = 0.899, p = 0.001; with GCS_M: AUROC = 0.880, p = 0.004). The results were similar with the C-GRApH and CAHP scores in predicting poor neurologic outcome. This study confirms the good prognostic performance of CA-specific scores to predict neurologic outcomes in OHCA patients treated with TTM. By adding new variables associated with the initial neurologic examinations, the prognoses of neurologic outcomes improved compared to the existing scoring models.
Highlights
Out-of-hospital cardiac arrest (OHCA) is a major public health problem that affects between 250,000 and 300,000 patients annually, with an average incidence of 55 OHCAs per 100,000 adults and a low (7%) survival rate [1]
The OHCA score had an area under the receiver operating characteristic curve (AUROC) of 0.844 (95% confidence interval (CI): 0.798–0.884), the C-GRApH score had an AUROC of 0.779, and the CAHP score had an AUROC of 0.872
This study confirms the good prognostic performance of CA-specific scores to predict neurologic outcomes in OHCA patients treated with temperature management (TTM)
Summary
Out-of-hospital cardiac arrest (OHCA) is a major public health problem that affects between 250,000 and 300,000 patients annually, with an average incidence of 55 OHCAs per 100,000 adults and a low (7%) survival rate [1]. Due to advances in post-cardiac arrest (CA) management during the past decades, therapeutic hypothermia, called targeted temperature management (TTM), is the standard treatment of choice for CA patients, demonstrating an improvement in mortality and neurologic outcomes [2, 3]. Despite intensive medical treatments, due to hypoxic damage to the brain and ischemia-reperfusion phenomena leading to a systemic inflammatory response, approximately two-thirds of initially resuscitated patients subsequently die in the hospital [4]. It is possible to allocate critical care resources by predicting the patient prognosis early
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