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Objective Despite recent advancements in post-cardiac arrest resuscitation, the optimal measurement of post-arrest outcome remains unclear. We hypothesized that cerebral performance category (CPC) score can predict the long-term outcome of post- arrest survivors who received targeted temperature management (TTM) during their post-arrest hospital care. Design Retrospective chart review. Setting Two academic medical centers from May, 2005 to December, 2012. Patients The medical records of 2,417 out-of-hospital and in-hospital post-cardiac arrest patients were reviewed to identify 140 out of 582 survivors who received TTM. Interventions None. Measurements and Main Results The CPC scores at hospital discharge were determined by three independent abstractors. The 1-month, 6-month, and 12-month survival of these patients were determined by reviewing hospital records, querying the Social Security Death Index, and follow-up telephone calls. The unadjusted long-term survival and adjusted survival association with CPC were calculated. Of the 2,417 identified cardiac arrest patients, 24.1% (582/2417) were successfully resuscitated, of whom 24.1% (140/582) received post-arrest TTM. Overall, 42.9% (60/140) were discharged with CPC 1, 27.1% (38/140) with CPC 2, 18.6% (26/140) with CPC 3, and 11.4% (16/140) with CPC 4. CPC 1 survivors had the highest long-term survival followed by CPC 2 and 3, with CPC 4 having the lowest long-term survival (p < 0.001, log-rank test). We found that CPC 3 (hazard ratio = 3.62, p < 0.05) and CPC 4 (hazard ratio = 12.73, p <0.001) remained associated with worse survival after adjusting for age, gender, race, shockable rhythm, time to TTM initiation, total duration of resuscitation, withdrawal of care, and location of arrest. Conclusion Patients with different CPC scores at discharge have significantly different survival trajectories. Favorable CPC at hospital discharge predicts better long-term outcomes of cardiac arrest survivors who received TTM than those with less favorable CPC scores.

Purpose Cerebral Performance Category (CPC) scores are often an outcome measure for post-arrest neurologic function, collected worldwide to compare performance, evaluate therapies, and formulate recommendations. At most institutions, no formal training is offered in their determination, potentially leading to misclassification. Materials and Methods We identified 171 patients at 2 hospitals between 5/10/2005 and 8/31/2012 with two CPC scores at hospital discharge recorded independently – in an in-house quality improvement database and as part of a national registry. Scores were abstracted retrospectively from the same electronic medical record by two separate non-clinical researchers. These scores were compared to assess inter-rater reliability and stratified based on whether the score was concordant or discordant among reviewers to determine factors related to discordance. Results Thirty-nine CPC scores (22.8%) were discordant (kappa: 0.66), indicating substantial agreement. When dichotomized into “favorable” neurologic outcome (CPC 1–2)/“unfavorable” neurologic outcome (CPC 3–5), 20 (11.7%) scores were discordant (kappa: 0.70), also indicating substantial agreement. Patients discharged home (as opposed to nursing/other care facility) and patients with suspected cardiac etiology of arrest were statistically more likely to have concordant scores. For the quality improvement database, patients with discordant scores had a statistically higher median CPC score than those with concordant scores. The registry had statistically lower median CPC score (CPC 1) than the quality improvement database (CPC 2); p < 0.01 for statistical significance. Conclusions CPC scores have substantial inter-rater reliability, which is reduced in patients who have worse outcomes, have a non-cardiac etiology of arrest, and are discharged to a location other than home.

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