CAST: a new score for early prediction of neurological outcomes after cardiac arrest before therapeutic hypothermia with high accuracy

Nishikimi, Mitsuaki; Matsuda, Naoyuki; Matsui, Kazumi; Takahashi, Kunihiko; Ejima, Tadashi; Liu, Keibun; Ogura, Takayuki; Higashi, Michiko; Umino, Hitoshi; Makishi, Go; Numaguchi, Atsushi; Matsushima, Satoru; Tokuyama, Hideki; Nakamura, Mitsunobu; Matsui, Shigeyuki

doi:10.1007/s00134-016-4492-3

Cited by 21 publications

(25 citation statements)

References 5 publications

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“…Beyond hemodynamic severity, the neurological prognosis should be also considered before the decision of ECLS in patients with post-resuscitation shock. Several scores have been proposed to assess neurological prognosis after OHCA [ 77 , 86 – 88 ] (Table 1 ) and could be useful to guide the therapeutic strategy in patients experiencing CA [ 77 ].…”

Section: Management Of Post-resuscitation Shockmentioning

confidence: 99%

Post-resuscitation shock: recent advances in pathophysiology and treatment

Jozwiak

Bougouin

Géri

et al. 2020

Ann. Intensive Care

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A post-resuscitation shock occurs in 50–70% of patients who had a cardiac arrest. It is an early and transient complication of the post-resuscitation phase, which frequently leads to multiple-organ failure and high mortality. The pathophysiology of post-resuscitation shock is complex and results from the whole-body ischemia–reperfusion process provoked by the sequence of circulatory arrest, resuscitation manoeuvers and return of spontaneous circulation, combining a myocardial dysfunction and sepsis features, such as vasoplegia, hypovolemia and endothelial dysfunction. Similarly to septic shock, the hemodynamic management of post-resuscitation shock is based on an early and aggressive hemodynamic management, including fluid administration, vasopressors and/or inotropes. Norepinephrine should be considered as the first-line vasopressor in order to avoid arrhythmogenic effects of other catecholamines and dobutamine is the most established inotrope in this situation. Importantly, the optimal mean arterial pressure target during the post-resuscitation shock still remains unknown and may probably vary according to patients. Mechanical circulatory support by extracorporeal membrane oxygenation can be necessary in the most severe patients, when the neurological prognosis is assumed to be favourable. Other symptomatic treatments include protective lung ventilation with a target of normoxia and normocapnia and targeted temperature management by avoiding the lowest temperature targets. Early coronary angiogram and coronary reperfusion must be considered in ST-elevation myocardial infarction (STEMI) patients with preserved neurological prognosis although the timing of coronary angiogram in non-STEMI patients is still a matter of debate. Further clinical research is needed in order to explore new therapeutic opportunities regarding inflammatory, hormonal and vascular dysfunction.

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Section: Management Of Post-resuscitation Shockmentioning

confidence: 99%

Post-resuscitation shock: recent advances in pathophysiology and treatment

Jozwiak

Bougouin

Géri

et al. 2020

Ann. Intensive Care

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“…After confirming the predictive accuracies of the rCAST scores for the outcomes, we developed the risk classification system based on the rCAST. Because they were cutoff values indicating 95% sensitivity and 95% specificity, the score points of 6 and 14.5, respectively, were set as the thresholds for classifying the subjects into three severity groups based on the rCAST; low severity category (rCAST ≤ 5.5), moderate severity category (rCAST, [6][7][8][9][10][11][12][13][14], and high severity category (rCAST ≥ 14.5) (Fig. 4).…”

Section: Resultsmentioning

confidence: 99%

“…In the study protocol, we used rCAST, a simplified version of the original CAST previously developed by us, taking account usage of the component factors in clinical practice [8,9]. The calculation of the CAST score is summarized in Supplemental Fig.…”

Section: Definition Of Rcastmentioning

confidence: 99%

“…Previously, we developed the "post-Cardiac Arrest Syndrome for Therapeutic hypothermia score (CAST)" for predicting the 30-day neurologic outcome of PCAS patients at the ED, prior to the initiation of TTM [8,9]. It was unique, in that it was created focusing on PCAS patients undergoing TTM, as well as was calculated at the ED prior to the initiation of TTM.…”

Section: Introductionmentioning

confidence: 99%

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External validation of a risk classification at the emergency department of post-cardiac arrest syndrome patients undergoing targeted temperature management

et al. 2019

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Introduction: There are no established risk classification for post-cardiac arrest syndrome (PCAS) patients at the Emergency Department (ED) undergoing targeted temperature management (TTM). The aim of this study was to externally validate a simplified version of our prognostic score, the "post-Cardiac Arrest Syndrome for Therapeutic hypothermia score" (revised CAST [rCAST]) and estimate the predictive accuracy of the risk classification based on it. Methods: For the external validation, we used data from an out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM), which is a multicenter, prospective registry of OHCA patients across Japan. Eligible patients were PCAS patients treated with TTM at 33ºC-36ºC between June 2014 and December 2015. We validated the accuracy of rCAST for predicting the neurological outcomes at 30 and 90 days. Results: Among the 12,024 OHCA patients, the data of 460 PCAS patients treated by TTM were eligible for the validation. The areas under the curve of rCAST for predicting the neurological outcomes at 30 and 90 days were 0.892 and 0.895, respectively. The estimated sensitivity and specificity of the risk categories for the outcomes were as follows: 0.95 (95% CI: 0.92-0.98) and 0.47 (0.40-0.55) for the low (rCAST: ≤5.5), 0.62 (0.56-0.68) and 0.48 (0.40-0.55) for the moderate (rCAST: 6.0-14.0), and 0.57 (0.51-0.63) and 0.95 2 (0.91-0.98) for the high severity category (rCAST: ≥14.5). Conclusions: The rCAST was useful for predicting the neurological outcomes with high accuracy in PCAS patients, and the three grades was developed for a risk classification based on the rCAST.

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“…Novel, innovative and readily applicable scoring systems for early prediction of neurological outcome [7] are needed. They may serve to guide patient's selection for full code life support such as veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with refractory cardiogenic shock following resuscitation [8].…”

mentioning

confidence: 99%