C‐GRApH : A Validated Scoring System for Early Stratification of Neurologic Outcome After Out‐of‐Hospital Cardiac Arrest Treated With Targeted Temperature Management

Abstract

BackgroundOut‐of‐hospital cardiac arrest (OHCA) results in significant morbidity and mortality, primarily from neurologic injury. Predicting neurologic outcome early post‐OHCA remains difficult in patients receiving targeted temperature management.Methods and ResultsRetrospective analysis was performed on consecutive OHCA patients receiving targeted temperature management (32–34°C) for 24 hours at a tertiary‐care center from 2008 to 2012 (development cohort, n=122). The primary outcome was favorable neurologic outcome at hospital discharge, defined as cerebral performance category 1 to 2 (poor 3–5). Patient demographics, pre‐OHCA diagnoses, and initial laboratory studies post‐resuscitation were compared between favorable and poor neurologic outcomes with multivariable logistic regression used to develop a simple scoring system (C‐GRApH). The C‐GRApH score ranges 0 to 5 using equally weighted variables: (C): coronary artery disease, known pre‐OHCA; (G): glucose ≥200 mg/dL; (R): rhythm of arrest not ventricular tachycardia/fibrillation; (A): age >45; (pH): arterial pH ≤7.0. A validation cohort (n=344) included subsequent patients from the initial site (n=72) and an external quaternary‐care health system (n=272) from 2012 to 2014. The c‐statistic for predicting neurologic outcome was 0.82 (0.74–0.90, P<0.001) in the development cohort and 0.81 (0.76–0.87, P<0.001) in the validation cohort. When subdivided by C‐GRApH score, similar rates of favorable neurologic outcome were seen in both cohorts, 70% each for low (0–1, n=60), 22% versus 19% for medium (2–3, n=307), and 0% versus 2% for high (4–5, n=99) C‐GRApH scores in the development and validation cohorts, respectively.Conclusions C‐GRApH stratifies neurologic outcomes following OHCA in patients receiving targeted temperature management (32–34°C) using objective data available at hospital presentation, identifying patient subsets with disproportionally favorable (C‐GRApH ≤1) and poor (C‐GRApH ≥4) prognoses.

Prognostic value of OHCA, C-GRApH and CAHP scores with initial neurologic examinations to predict neurologic outcomes in cardiac arrest patients treated with targeted temperature management

“…To date, various scoring models have been suggested for predicting the neurologic outcomes after CA [5][6][7]. In the initial development of estimation models, an OHCA score was suggested in France [5].…”

“…The model included each parameter that was available upon admission to the intensive care unit (ICU), including initial rhythm, estimated no-flow (time from collapse to the initiation of cardiopulmonary resuscitation (CPR)) and low-flow intervals (time from CPR to the return of spontaneous circulation (ROSC)), blood lactate levels, and creatinine levels. Another model is the C-GRApH score, which consists of known coronary artery disease before OHCA, glucose �200 mg/dL, rhythm of arrest not ventricular tachycardia/fibrillation, age >45, and arterial pH �7.0 [7]. Lastly, the CAHP score model, which can be calculated using a previously published nomogram, consists of variables independently associated with poor neurologic outcome: age, arrest setting (location of arrest, public vs. home), initial rhythm (shockable or not), duration from the initial collapse to basic life support (BLS) and from BLS to ROSC, pH, and epinephrine dose (0, 1-2, 3) [6].…”

Neurologic prognostication after resuscitation from cardiac arrest

“…Using these parameters, a score of over 16 had 96% specificity for a poor neurologic outcome. The second score was the C‐GRApH score, which combined history of known coronary artery disease, initial glucose ≥200 mg/dL, non‐shockable initial rhythm, age over 45, and initial pH ≤ 7.0 69 . A score of 4 or greater had a specificity of 97% for poor outcomes.…”

Újraélesztést követő koszorúér-angiográfia és katéteres intervenció

“…Nemrégiben amerikai kutatók is egy új, a resuscitatiót követő kedvezőtlen kimenetelt nagyon érzékenyen előjelző egyszerű pontrendszert mutattak be. A "C-GRApH" score mindössze 5 tényező alapján ad pontokat, ezek az anamnesztikus koszorúér-betegség, a 11 mmol/l feletti vércukorszint, a nem sokkolható kezdeti ritmus, a 45 évet meghaladó életkor és a 7,0 alatti pH [35]. Hasonló rendszert francia kutatók is kidolgoztak már.…”