Age, pre-arrest neurological condition, and functional status as outcome predictors in out-of-hospital cardiac arrest: Secondary analysis of the Jerusalem Cohort Study data

Marcus, Esther‐Lee; Chigrinskiy, Pavel; Deutsch, Lisa; Einav, Sharon

doi:10.1016/j.archger.2020.104317

Cited by 8 publications

(13 citation statements)

References 28 publications

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“…Our study, which includes all the OHCA cases that occurred in four provinces and were filed according to the Utstein style recommendations, should overcome selection bias. This is similar to four studies carried out in Israel ( 31 ), Canada ( 32 ), and Australia ( 33 – 35 ). Marcus et al ( 31 ) looked for differences in both survival and survival with good neurological outcome between patients aged over and under 80 years.…”

Section: Discussionsupporting

confidence: 89%

“…This is similar to four studies carried out in Israel ( 31 ), Canada ( 32 ), and Australia ( 33 – 35 ). Marcus et al ( 31 ) looked for differences in both survival and survival with good neurological outcome between patients aged over and under 80 years. They showed how younger patients had a better outcome, which is consistent with our results, as we also confirmed age as a direct predictor of long-term mortality.…”

Section: Discussionsupporting

confidence: 89%

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Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis

Baldi

Compagnoni

Buratti

et al. 2021

Front. Cardiovasc. Med.

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Background: No data are available regarding long-term survival of out-of-hospital cardiac arrest (OHCA) patients based on different Utstein subgroups, which are expected to significantly differ in terms of survival. We aimed to provide the first long-term survival analysis of OHCA patients divided according to Utstein categories.Methods: We analyzed all the 4,924 OHCA cases prospectively enrolled in the Lombardia Cardiac Arrest Registry (Lombardia CARe) from 2015 to 2019. Pre-hospital data, survival, and cerebral performance category score (CPC) at 1, 6, and 12 months and then every year up to 5 years after the event were analyzed for each patient.Results: A decrease in survival was observed during the follow-up in all the Utstein categories. The risk of death of the “all-EMS treated” group exceeded the general population for all the years of follow-up with standardized mortality ratios (SMRs) of 23 (95%CI, 16.8–30.2), 6.8 (95%CI, 3.8–10.7), 3.8 (95%CI, 1.7–6.7), 4.05 (95%CI, 1.9–6.9), and 2.6 (95%CI, 1.03–4.8) from the first to the fifth year of follow-up. The risk of death was higher also for the Utstein categories “shockable bystander witnessed” and “shockable bystander CPR”: SMRs of 19.4 (95%CI, 11.3–29.8) and 19.4 (95%CI, 10.8–30.6) for the first year and of 6.8 (95%CI, 6.6–13) and 8.1 (95%CI, 3.1–15.3) for the second one, respectively. Similar results were observed considering the patients discharged with a CPC of 1–2.Conclusions: The mortality of OHCA patients discharged alive from the hospital is higher than the Italian standard population, also considering those with the most favorable OHCA characteristics and those discharged with good neurological outcome. Long-term follow-up should be included in the next Utstein-style revision.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis

Baldi

Compagnoni

Buratti

et al. 2021

Front. Cardiovasc. Med.

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“…After removing duplicates (n = 5296), the remaining 10 051 records were screened on titles and abstracts. Of the resulting 854 full-text articles, 38 studies were included in the final qualitative and quantitative analysis. A total of 21 studies with 11 800 patients were used for KM-based meta-analysis, whereas 33 studies with 16 933 patients were used for aggregate data meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Of the resulting 854 full-text articles, 38 studies were included in the final qualitative and quantitative analysis. A total of 21 studies with 11 800 patients were used for KM-based meta-analysis, whereas 33 studies with 16 933 patients were used for aggregate data meta-analysis. eFigure 1 in the Supplement outlines the study selection process.…”

Section: Resultsmentioning

confidence: 99%

Long-term Survival After Out-of-Hospital Cardiac Arrest

et al. 2022

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IMPORTANCE Data on long-term survival beyond 12 months after out-of-hospital cardiac arrest (OHCA) of a presumed cardiac cause are scarce.OBJECTIVE To investigate the long-term survival of adult patients after surviving the initial hospital stay for an OHCA.DATA SOURCES A systematic search of the EMBASE and MEDLINE databases was performed from database inception to March 25, 2021.STUDY SELECTION Clinical studies reporting long-term survival after OHCA were selected based on predefined inclusion and exclusion criteria according to a preregistered study protocol.DATA EXTRACTION AND SYNTHESIS Patient data were reconstructed from Kaplan-Meier curves using an iterative algorithm and then pooled to generate survival curves. As a separate analysis, an aggregate data meta-analysis was performed. MAIN OUTCOMES AND MEASURESThe primary outcome was long-term survival (>12 months) after OHCA for patients surviving to hospital discharge or 30 days after OHCA. RESULTSThe search identified 15 347 reports, of which 21 studies (11 800 patients) were included in the Kaplan-Meier-based meta-analysis and 33 studies (16 933 patients) in an aggregate data meta-analysis. In the Kaplan-Meier-based analysis, the median survival time for patients surviving to hospital discharge was 5.0 years (IQR, 2.3-7.9 years). The estimated survival rates were 82.8% (95% CI, 81.9%-83.7%) at 3 years, 77.0% (95% CI, 75.9%-78.0%) at 5 years, 63.9% (95% CI, 62.3%-65.4%) at 10 years, and 57.5% (95% CI, 54.8%-60.1%) at 15 years. Compared with patients with a nonshockable initial rhythm, patients with a shockable rhythm had a lower risk of long-term mortality (hazard ratio, 0.30; 95% CI, 0.23-0.39; P < .001). Different analyses, including an aggregate data meta-analysis, confirmed these results. CONCLUSIONS AND RELEVANCEIn this comprehensive systematic review and meta-analysis, long-term survival after 10 years in patients surviving the initial hospital stay after OHCA was between 62% and 64%. Additional research is needed to understand and improve the long-term survival in this vulnerable patient population.

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“…Of those who have restoration of spontaneous circulation (ROSC) after initial resuscitation, a large proportion die before discharge, and only a minority of patients with cardiac arrest achieve favorable functional outcome at discharge 1 , 4 . However, it is noteworthy that several factors, including patients’ age, pre-arrest neurological condition, functional status, rhythm type (shockable vs non-shockable) play vital role in the outcome of OHCA 5 , 6 . In context of these outcome predictors, we note that of the minority of patients who are discharged alive with favorable functional status, the proportion sdischarged with favorable neurological status is relatively high 6 , and this may explain the attribution of majority of OHCA post-resuscitation deaths to brain injury 7 , howbeit without accounting for deaths due to early withdrawal of life-sustaining treatment which in itself frequently truncates the opportunity for brain recovery 8 .…”

Section: Introductionmentioning

confidence: 99%

Artificial neural network-boosted Cardiac Arrest Survival Post-Resuscitation In-hospital (CASPRI) score accurately predicts outcome in cardiac arrest patients treated with targeted temperature management

Chou

Bamodu

Chiu

et al. 2022

Sci Rep

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Existing prognostic models to predict the neurological recovery in patients with cardiac arrest receiving targeted temperature management (TTM) either exhibit moderate accuracy or are too complicated for clinical application. This necessitates the development of a simple and generalizable prediction model to inform clinical decision-making for patients receiving TTM. The present study explores the predictive validity of the Cardiac Arrest Survival Post-resuscitation In-hospital (CASPRI) score in cardiac arrest patients receiving TTM, regardless of cardiac event location, and uses artificial neural network (ANN) algorithms to boost the prediction performance. This retrospective observational study evaluated the prognostic relevance of the CASPRI score and applied ANN to develop outcome prediction models in a cohort of 570 patients with cardiac arrest and treated with TTM between 2014 and 2019 in a nationwide multicenter registry in Taiwan. In univariate logistic regression analysis, the CASPRI score was significantly associated with neurological outcome, with the area under the receiver operating characteristics curve (AUC) of 0.811. The generated ANN model, based on 10 items of the CASPRI score, achieved a training AUC of 0.976 and validation AUC of 0.921, with the accuracy, precision, sensitivity, and specificity of 89.2%, 91.6%, 87.6%, and 91.2%, respectively, for the validation set. CASPRI score has prognostic relevance in patients who received TTM after cardiac arrest. The generated ANN-boosted, CASPRI-based model exhibited good performance for predicting TTM neurological outcome, thus, we propose its clinical application to improve outcome prediction, facilitate decision-making, and formulate individualized therapeutic plans for patients receiving TTM.

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Age, pre-arrest neurological condition, and functional status as outcome predictors in out-of-hospital cardiac arrest: Secondary analysis of the Jerusalem Cohort Study data

Cited by 8 publications

References 28 publications

Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis

Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis

Long-term Survival After Out-of-Hospital Cardiac Arrest

Artificial neural network-boosted Cardiac Arrest Survival Post-Resuscitation In-hospital (CASPRI) score accurately predicts outcome in cardiac arrest patients treated with targeted temperature management

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