The Sequential Organ Failure Assessment or SOFA score was developed to assess the acute morbidity of critical illness at a population level and has been widely validated as a tool for this purpose across a range of healthcare settings and environments.In recent years, the SOFA score has become extensively used in a range of other applications. A change in the SOFA score of 2 or more is now a defining characteristic of the sepsis syndrome, and the European Medicines Agency has accepted that a change in the SOFA score is an acceptable surrogate marker of efficacy in exploratory trials of novel therapeutic agents in sepsis. The requirement to detect modest serial changes in a patients’ SOFA score therefore means that increased clarity on how the score should be assessed in different circumstances is required.This review explores the development of the SOFA score, its applications and the challenges associated with measurement. In addition, it proposes guidance designed to facilitate the consistent and valid assessment of the score in multicentre sepsis trials involving novel therapeutic agents or interventions.ConclusionThe SOFA score is an increasingly important tool in defining both the clinical condition of the individual patient and the response to therapies in the context of clinical trials. Standardisation between different assessors in widespread centres is key to detecting response to treatment if the SOFA score is to be used as an outcome in sepsis clinical trials.

Vasoplegia is the syndrome of pathological low systemic vascular resistance, the dominant clinical feature of which is reduced blood pressure in the presence of a normal or raised cardiac output. The vasoplegic syndrome is encountered in many clinical scenarios, including septic shock, post-cardiac bypass and after surgery, burns and trauma, but despite this, uniform clinical definitions are lacking, which renders translational research in this area challenging. We discuss the role of vasoplegia in these contexts and the criteria that are used to describe it are discussed. Intrinsic processes which may drive vasoplegia, such as nitric oxide, prostanoids, endothelin-1, hydrogen sulphide and reactive oxygen species production, are reviewed and potential for therapeutic intervention explored. Extrinsic drivers, including those mediated by glucocorticoid, catecholamine and vasopressin responsiveness of the blood vessels, are also discussed. The optimum balance between maintaining adequate systemic vascular resistance against the potentially deleterious effects of treatment with catecholamines is as yet unclear, but development of novel vasoactive agents may facilitate greater understanding of the role of the differing pathways in the development of vasoplegia. In turn, this may provide insights into the best way to care for patients with this common, multifactorial condition.

AimThe aim of the study reported here was to address the need to assess and train teamwork and non-technical skills in the context of Resuscitation. Specifically, we sought to develop a tool that is feasible to use and psychometrically sound to assess team behaviours during cardiac arrest resuscitation attempts.MethodsTo ensure validity, reliability, and feasibility, the Observational Skill based Clinical Assessment tool for Resuscitation (OSCAR) was developed in 3 phases. A review of the literature leading to initial tool development was followed by an assessment of face and content validity, and finally a thorough reliability assessment, using Cronbach's α to assess internal consistency and intraclass correlation to assess inter-rater reliability.ResultsOSCAR was developed methodically, and tested for face and content validity. Cronbach's α results ranged from 0.736 to 0.965 demonstrating high internal consistency, and intraclass correlation results ranged from 0.652 to 0.911, all of which are strongly significant and indicate good inter-rater reliability.ConclusionOn the basis of our results, we conclude that OSCAR is psychometrically robust, scientifically sound, and clinically relevant. We have developed the Observational Skill-based Clinical Assessment tool for Resuscitation (OSCAR) for the assessment of non-technical skills in Resuscitation teams. We propose the use of this tool in simulation and real Cardiac Arrest Resuscitation attempts to assess, guide and train non-technical skills to team members, to improve patient safety and maximise the chances of successful resuscitation.