COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation

Abstract

Cardiac arrest effectiveness trials have traditionally reported outcomes that focus on survival. A lack of consistency in outcome reporting between trials limits the opportunities to pool results for meta-analysis. The COSCA initiative (Core Outcome Set for Cardiac Arrest), a partnership between patients, their partners, clinicians, research scientists, and the International Liaison Committee on Resuscitation, sought to develop a consensus core outcome set for cardiac arrest for effectiveness trials. Core outcome sets are primarily intended for large, randomized clinical effectiveness trials (sometimes referred to as or) rather than for pilot or efficacy studies. A systematic review of the literature combined with qualitative interviews among cardiac arrest survivors was used to generate a list of potential outcome domains. This list was prioritized through a Delphi process, which involved clinicians, patients, and their relatives/partners. An international advisory panel narrowed these down to 3 core domains by debate that led to consensus. The writing group refined recommendations for when these outcomes should be measured and further characterized relevant measurement tools. Consensus emerged that a core outcome set for reporting on effectiveness studies of cardiac arrest (COSCA) in adults should include survival, neurological function, and health-related quality of life. This should be reported as survival status and modified Rankin scale score at hospital discharge, at 30 days, or both. Health-related quality of life should be measured with ≥1 tools from Health Utilities Index version 3, Short-Form 36-Item Health Survey, and EuroQol 5D-5L at 90 days and at periodic intervals up to 1 year after cardiac arrest, if resources allow.

Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

“…We did show in a sensitivity analysis with the studies that reported data for the same follow-up moment that the estimates were very similar to the main analysis. However, a standardized and comprehensive assessment of neurologic and functional outcomes in cardiac arrest research is needed [9]. In spite of these differences, we encountered homogenous results, which suggests that the time of outcome assessment did not signi cantly in uence the results: the neurological outcome and survival seem to remain constant at different follow-up times.…”

A systematic review and meta-analysis of the effect of dispatcher-assisted CPR on outcomes from sudden cardiac arrest in adults and children

“…This should be a key consideration in the design of future studies/trials, as per the recommendations of the recent Core Outcomes in Sudden Cardiac Arrest (COSCA) statement. 53…”

Age‐associated outcomes after survived out‐of‐hospital cardiac arrest and subsequent target temperature management

“…Of course, the strengths of the CPC include its extensive use, simplicity, and it is a useful surrogate measure of long‐term outcome . Other measure techniques or scores may possess greater predictive characteristics . Due to the several limitations, results of the present study cannot be easily extrapolated to OHCA patients in general.…”

“…With the CPC score, we also used a common outcome parameter . However, in a recently published advisory statement from the international liaison committee on resuscitation, the CPC score has been described to have some limitations, ie, ceiling effects and overestimation of function . Therefore, maybe the modified Rankin Scale (mRS) should be preferred to evaluate the neurological function.…”