Using Out-of-Hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP) Scores with Modified Objective Data to Improve Neurological Prognostic Performance for Out-of-Hospital Cardiac Arrest Survivors

Abstract

This study aimed to determine whether accuracy and sensitivity concerning neurological prognostic performance increased for survivors of out-of-hospital cardiac arrest (OHCA) treated with targeted temperature management (TTM), using OHCA and cardiac arrest hospital prognosis (CAHP) scores and modified objective variables. We retrospectively analyzed non-traumatic OHCA survivors treated with TTM. The primary outcome was poor neurological outcome at 3 months after return of spontaneous circulation (cerebral performance category, 3–5). We compared neurological prognostic performance using existing models after adding objective data obtained before TTM from computed tomography (CT), magnetic resonance imaging (MRI), and biomarkers to replace the no-flow time component of the OHCA and CAHP models. Among 106 patients, 61 (57.5%) had poor neurologic outcomes. The area under the receiver operating characteristic (AUROC) curve for the OHCA and CAHP models was 0.89 (95% confidence interval (CI) 0.81–0.94) and 0.90 (95% CI 0.82–0.95), respectively. The prediction of poor neurological outcome improved after replacing no-flow time with a grey/white matter ratio measured using CT, high-signal intensity (HSI) on diffusion-weighted MRI (DWI), percentage of voxel using apparent diffusion coefficient value, and serum neuron-specific enolase levels. When replaced with HSI on DWI, the AUROC and sensitivity of the OHCA and CAHP models were 0.96 and 74.5% and 0.97 and 83.8%, respectively (100% specificity). Prognoses concerning neurologic outcomes improved compared with existing OHCA and CAHP models by adding new objective variables to replace no-flow time. External validation is required to generalize these results in various contexts.

Comparison of different clinical risk scores to predict long-term survival and neurological outcome in adults after cardiac arrest: results from a prospective cohort study

“…The findings of this study are generally in line with previous validation studies evaluating outcomes at hospital discharge or 30 days post-event, where the CAHP score showed a slightly better performance than the OHCA score [ 29 , 30 , 33 , 48 ]. In two different cohorts of cardiac arrest patients evaluating outcomes at hospital discharge [ 49 ] or 90 days [ 32 ] the OHCA score performed somewhat better than the CAHP score. The severity-of-illness scores had a slightly inferior performance when compared to the cardiac arrest-specific scores, which was also noted in previous studies looking at short-term outcomes [ 29 , 50 , 51 ].…”

“…One may argue that the development of new scores for the prognostication of long-term outcomes may not provide additional value, as established scores perform well in predicting long-term outcomes. Efforts to improve established scoring systems by adding known predictors of outcome after cardiac arrest, such as laboratory parameters (e. g., neuron-specific enolase), imaging or electrophysiological examination results, or clinical signs (e. g., GCS motor score) have shown promising results [ 30 , 32 , 40 ]. Such modifications with corresponding validation studies might be helpful to keep established scores up to date and improve their predictive value based on current and evolving science.…”

“…The severity-of-illness scores APACHE II (Acute Physiology and Chronic Health Evaluation II) and SAPS II (Simplified Acute Physiology Score II) have been widely used in critical care research, and the required clinical and laboratory parameters are readily available for all post-cardiac-arrest patients [24,25]. All four scores were successfully validated for the prediction of short-term neurological outcomes and mortality [26][27][28][29][30][31][32][33][34][35]. However, these scores have not been evaluated regarding long-term outcomes.…”

Variation in practice for out‐of‐hospital cardiac arrest treated with percutaneous coronary intervention in England and Wales

“…This discrepant practice demands further attention, as currently survivors of OHCA are often taken to the nearest hospital which may not necessarily be PCI center. Development of a centralized approach in the form of regional cardiac arrest centers, incorporation of appropriate risk stratification and deployment of a full range of support treatment options such as targeted temperature management (TTM), mechanical circulatory support, delivered by a specialist multidisciplinary team may facilitate improved outcomes 28–31 …”

“…Development of a centralized approach in the form of regional cardiac arrest centers, incorporation of appropriate risk stratification and deployment of a full range of support treatment options such as targeted temperature management (TTM), mechanical circulatory support, delivered by a specialist multidisciplinary team may facilitate improved outcomes. [28][29][30][31] To the best of our knowledge, this is the first national multicentre cohort study of OHCA patients treated with PCI, characterizing these patients' clinical and angiographic profiles. We demonstrated the variation in clinical practice across PCI centers based on the hospital overall and PPCI volume and its correlation with OHCA PCI.…”