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

Abstract

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.

Simultaneous External Validation of Various Cardiac Arrest Prognostic Scores: a Single-center Retrospective Study

“…For example, the targets for the NULL-PLEASE score were all OHCA patients, whereas those for the OHCA and CAHP scores were restricted to bystander-witnessed OHCA patients [4,6]. Furthermore, the targets of CAST and rCAST scores were restricted to OHCA patients in whom therapeutic hypothermia was induced [10,11]. However, where possible, we were able to evaluate the prognostic scores in various OHCA patient subgroups, regardless of the original targets.…”

“…The "nonshockable rhythm, unwitnessed arrest, long no-ow or long low-ow period, blood pH < 7.2, lactate > 7.0 mmol/L, end-stage chronic kidney disease, age ≥ 85 years, still resuscitation, and extracardiac cause" (NULL-PLEASE) clinical score was devised to identify patients unlikely to survive out-of-hospital cardiac arrest using several unfavorable cardiac arrest-or patient-related characteristics [7]. Recently, the postcardiac arrest syndrome for therapeutic hypothermia (CAST) score and revised CAST (rCAST) score were developed to predict the neurologic prognosis in patients after resuscitation following cardiac arrest, prior to inducing therapeutic hypothermia [10,11]. The variables required to calculate each predictive score are summarized in Table 1 [4,6,7,10,11].…”

“…Recently, the postcardiac arrest syndrome for therapeutic hypothermia (CAST) score and revised CAST (rCAST) score were developed to predict the neurologic prognosis in patients after resuscitation following cardiac arrest, prior to inducing therapeutic hypothermia [10,11]. The variables required to calculate each predictive score are summarized in Table 1 [4,6,7,10,11].…”

Simultaneous external validation of various cardiac arrest prognostic scores: a single-center retrospective study

“…The “non-shockable rhythm, unwitnessed arrest, long no-flow or long low-flow period, blood pH < 7.2, lactate > 7.0 mmol/L, end-stage chronic kidney disease, age ≥ 85 years, still resuscitation, and extracardiac cause” (NULL-PLEASE) clinical score was devised to identify patients unlikely to survive out-of-hospital cardiac arrest using several unfavorable cardiac arrest- or patient-related characteristics [ 7 ]. Recently, the post-cardiac arrest syndrome for therapeutic hypothermia (CAST) score and revised CAST (rCAST) score were developed to predict the neurologic prognosis in patients after resuscitation following cardiac arrest, prior to inducing therapeutic hypothermia [ 10 , 11 ]. The variables required to calculate each predictive score are summarized in Table 1 [ 4 , 6 , 7 , 10 , 11 ].…”

“…Recently, the post-cardiac arrest syndrome for therapeutic hypothermia (CAST) score and revised CAST (rCAST) score were developed to predict the neurologic prognosis in patients after resuscitation following cardiac arrest, prior to inducing therapeutic hypothermia [ 10 , 11 ]. The variables required to calculate each predictive score are summarized in Table 1 [ 4 , 6 , 7 , 10 , 11 ].…”