Derivation and Validation of the CREST Model for Very Early Prediction of Circulatory Etiology Death in Patients Without ST-Segment–Elevation Myocardial Infarction After Cardiac Arrest

Bascom, Karen E.; Dziodzio, John; Vasaiwala, Samip; Mooney, M.; Patel, Nainesh C; McPherson, John; McMullan, Paul W.; Unger, Barbara; Nielsen, Niklas; Friberg, Hans; Riker, Richard R.; Kern, Karl B.; Duarte, Christine W.; Seder, David B.; May, Teresa; Sunde, Kjetil; Rubertsson, Sten; Šmíd, Ondřej; Søreide, Eldar; Hand, R. Chris; Rundgren, Malin; Valsson, Felix; Sadaka, Farid; Bekkers, Bas; Wanscher, Michael; Lindell, Eva-Lotta; Guldbrand, Pehr; Torstensson, Anders; Dybkowska, Krystyna; Israelsson, Johan; Skram, Ulrik; Guzowski, Michelle; Hopf, Hans‐Bernd; Persson, Stefan; Chang, Ira; Samuelsson, Line; Oddby, Eva; Savolainen, Kristina; Zätterman, Richard; Rodríguez, Daniel; Mayer, Stephan A.; Födisch, M.; B, Oscarsson; Scheer, Håkan; Sarbinowski, R. T.; Hyddmark, Ulf; Deye, Nicolas; Lindbom, Anna; Armani, Claudia; Forsberg, Sune; Ericsson, Anders

doi:10.1161/circulationaha.116.024332

Cited by 43 publications

(28 citation statements)

References 42 publications

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“…The main issue is to identify the most suitable patients with post-resuscitation shock eligible for ECLS. Bascom and colleagues have proposed to use the “CREST score” (Table 1 ) for early identification of patients carrying the highest risk of circulatory-related death after CA, who could, therefore, be elective candidates for ECLS [ 82 ]. It has also been shown that in patients with post-resuscitation shock treated by ECLS, admission SOFA score < 14, initial shockable rhythm and international normalized ratio < 2.4 as well as initial arterial pH (odds ratio = 1.7 per 0.1 increase) and implantation of ECLS later than 24 h after ROSC were associated with survival and thus could be useful triage tools in such patients [ 83 , 84 ].…”

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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“…Our findings also revealed a tendency for more severe CAD and larger infarcts sizes (reflected by higher troponin elevations) in non-survivors although it didn't reach statistical significance, pointing to the need of larger studies to prove its impact on survival LVEF is considered an echocardiographic measure of myocardial dysfunction but its prognostic significance in OHCA patients is controversial and robust data is missing. Some observational studies report an association between LV dysfunction and survival [27,28] while others [3,29,30], like ours, found that it doesn't impact outcomes. Interestingly, Jentzer et al, showed that diastolic dysfunction is associated with inhospital and long-term mortality, considering it a more important variable in predicting patient outcomes [31].…”

Section: Cardiac Findingsmentioning

confidence: 45%

Predictors of In-Hospital Mortality after Recovered Out-of-Hospital Cardiac Arrest in Patients with Proven Significant Coronary Artery Disease: A Retrospective Study

Trêpa

Bastos

Fontes-Oliveira

et al. 2020

The Journal of Critical Care Medicine

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IntroductionRecovered Out-of-Hospital Cardiac Arrest (rOHCA) population is heterogenous. Few studies focused on outcomes in the rOHCA subgroup with proven significant coronary artery disease (SigCAD). We aimed to characterize this subgroup and study the determinants of in-hospital mortality.MethodsRetrospective study of consecutive rOHCA patients submitted to coronary angiography. Only patients with SigCAD were included.Results60 patients were studied, 85% were male, mean age was 62.6 ± 12.1 years. In-hospital mortality rate was 43.3%. Patients with diabetes and history of stroke were less likely to survive. Significant univariate predictors of in-hospital mortality were further analysed separately, according to whether they were present at hospital admission or developed during hospital evolution. At hospital admission, initial non-shockable rhythm, low-flow time>12min, pH<7.25mmol/L and lactates >4.75mmol/L were the most relevant predictors and therefore included in a score tested by Kaplan-Meyer. Patients who had 0/4 criteria had 100% chance of survival till hospital discharge, 1/4 had 77%, 2/4 had 50%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. During in-hospital evolution, a pH<7.35 at 24h, lactates>2mmol/L at 24h, anoxic brain injury and persistent hemodynamic instability proved significant. Patients who had 0/4 of these in-hospital criteria had 100% chance of survival till hospital discharge, 1/4 had 94%, 2/4 had 47%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. Contrarily, CAD severity and ventricular dysfunction didn’t significantly correlate to the outcome.ConclusionClassic prehospital variables retain their value in predicting mortality in the specific group of OHCA with SigCAD. In-hospital evolution variables proved to add value in mortality prediction. Combining these simple variables in risk scores might help refining prognostic prediction in these patients’s subset.

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“…The CREST model identified five variables in patients without ST elevation that could predict, with moderate accuracy, patients at higher risk of cardiac aetiology death. [143] Integration of these risk scores into prospective clinical trials may provide objective information to support decision making on arrival to the cardiac catheterisation laboratory.…”

Section: Management In the Cardiac Catheterisation Laboratorymentioning

confidence: 99%

Contemporary Management of Out-of-hospital Cardiac Arrest in the Cardiac Catheterisation Laboratory: Current Status and Future Directions

et al. 2019

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Out-of-hospital cardiac arrest (OHCA) is an important cause of mortality and morbidity in developed countries and remains an important public health burden. A primary cardiac aetiology is common in OHCA patients, and so patients are increasingly brought to specialist cardiac centres for consideration of coronary angiography, percutaneous coronary intervention and mechanical circulatory support. This article focuses on the management of OHCA in the cardiac catheterisation laboratory. In particular, it addresses conveyance of the OHCA patient direct to a specialist centre, the role of targeted temperature management, pharmacological considerations, provision of early coronary angiography and mechanical circulatory support.

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Derivation and Validation of the CREST Model for Very Early Prediction of Circulatory Etiology Death in Patients Without ST-Segment–Elevation Myocardial Infarction After Cardiac Arrest

Cited by 43 publications

References 42 publications

Post-resuscitation shock: recent advances in pathophysiology and treatment

Post-resuscitation shock: recent advances in pathophysiology and treatment

Predictors of In-Hospital Mortality after Recovered Out-of-Hospital Cardiac Arrest in Patients with Proven Significant Coronary Artery Disease: A Retrospective Study

Contemporary Management of Out-of-hospital Cardiac Arrest in the Cardiac Catheterisation Laboratory: Current Status and Future Directions

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