Predicting Outcomes of In-Hospital Cardiac Arrest: Retrospective US Validation of the Good Outcome Following Attempted Resuscitation Score

Abstract

BACKGROUND: Providers should estimate a patient's chance of surviving an in-hospital cardiac arrest with good neurologic outcome when initially admitting a patient, in order to participate in shared decision making with patients about their code status. OBJECTIVE: To examine the utility of the "Good Outcome Following Attempted Resuscitation (GO-FAR)" score in predicting prognosis after in-hospital cardiac arrest in a US trauma center. DESIGN: Retrospective observational study SETTING: Level 1 trauma and academic hospital in Minneapolis, MN, USA PARTICIPANTS: All cases of pulseless in-hospital cardiac arrest occurring in adults (18 years or older) admitted to the hospital between Jan 2009 and Sept 2018 are included. For patients with more than one arrest, only the first was included in this analysis. MAIN MEASURES: For each patient with verified inhospital cardiac arrest, we calculated a GO-FAR score based on variables present in the electronic health record at time of admission. Pre-determined outcomes included survival to discharge and survival to discharge with good neurologic outcome. KEY RESULTS: From 2009 to 2018, 403 adults suffered in-hospital cardiac arrest. A majority (65.5%) were male with a mean age of 60.3 years. Overall survival to discharge was 33.0%; survival to discharge with good neurologic outcome was 17.4%. GO-FAR score calculated at the time of admission correlated with survival to discharge with good neurologic outcome (AUC 0.68), which occurred in 5.3% of patients with below average survival likelihood by GO-FAR score, 22.5% with average survival likelihood, and 34.1% with above average survival likelihood. CONCLUSIONS: The GO-FAR score can estimate, at time of admission to the hospital, the probability that a patient will survive to discharge with good neurologic outcome after an in-hospital cardiac arrest. This prognostic information can help providers frame discussions with patients on admission regarding whether to attempt cardiopulmonary resuscitation in the event of cardiac arrest.

Survival of In-Hospital Cardiac Arrest in COVID-19 Infected Patients

“…The GO-FAR score (Good Outcome Following Attempted Resuscitation) is a clinically validated risk score that utilizes pre-arrest variables to predict the probability of survival to hospital discharge following IHCA [8]. These variables include age, neurologic status on admission, organ status on admission (kidney, liver, cardiac or respiratory failure), and cardiac versus non-cardiac diagnosis on admission.…”

Impact of Coronavirus Disease 2019 Pandemic on Cardiac Arrest and Emergency Care

“…However, the ability to predict outcome for patients with IHCA is challenging. The GO-FAR Score (Good Outcome Following Attempted Resuscitation) is a validated scoring system that uses pre-arrest variables to predict the probability of survival to hospital discharge following IHCA [ 43 ]. In the aforementioned study by Aldabagh et al, actual survival was compared to the GO-FAR Score in 450 patients with IHCA [ 30 ].…”

Medical futility regarding cardiopulmonary resuscitation in in-hospital cardiac arrests of adult patients: A systematic review and Meta-analysis

“…1). 24,26,27,29,34,35,39,42,45,47,48 and in European countries such as Sweden, 4,28,31,49 and England. 40,41,44 Study sample sizes ranged from 29 to 96,499 per trial.…”

“…40,41,44 Study sample sizes ranged from 29 to 96,499 per trial. Half of the studies included hospitalized patients receiving CPR after IHCA 1,4,24,33,34,[26][27][28][41][42][43][46][47][48][49] and in three studies the study population consisted of hospitalized patients without IHCA. 25,30,40,52 Yet, some studies included more specific patient populations such as elderly patients, 35,44 oncological patients, 36,38 critically ill patients, 39 severe burn patients, 32 or patients with multiple IHCA.…”