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.

research mentor, and to Dr. Venu Menon, my cardiology fellowship program director and original sponsor of this specific research pursuit and my scholarship award for the CRSP program. Both have been wonderful professional and personal role models for me and have supported me steadfastly through difficult personal times. I am fortunate to call them both great friends. Thanks to Dr. Mehdi Razavi, who provided the funding for the completion of this degree. This project began nearly 8 years ago during my intern year at the University of Virginia. It first culminated in creation of the C-GRApH scoring system, published in JAHA in 2017, and now has led to this extended post-hoc pH analysis in my last year of postgraduate training. In Charlottesville, I owe thanks to Drs.

Targeted temperature management has become a standard of care in many intensive care settings. The role of nursing is critical as we consider the use of these new approaches to maintaining temperature control and inducing hypothermia in our patient populations. Indeed, the successful use of various new cooling devices many times falls on the nursing staff to maintain strict guidelines for use as well as troubleshooting problems. A series of state-of-the-art lectures presented at the 2014 Therapeutic Hypothermia and Temperature Management meeting in Miami brought together several experts to discuss their experiences with utilizing therapeutic hypothermia and temperature management strategies at their institutions and hospitals. Dr. Justin Lundbye, chief of cardiology at the Hospital of Central Connecticut, moderated this session. Mr. Mark Adams, Virginia Health System, University of Virginia, discussed collaborative efforts for the use of therapeutic hypothermia on injured patients. A major point of discussion was whether therapeutic hypothermia medicine is a nurse's therapy. Dr. Kelly Sawyer, Department of Emergency Medicine, William Beaumont School of Medicine, discussed targeted temperature management and out-ofhospital cardiac arrest in survivors undergoing therapeutic hypothermia. Ms. Deborah Klein, Cleveland Clinic, spoke on therapeutic hypothermia after cardiac arrest and strategies for a successful program. Specific issues discussed included steps in the implementation of a therapeutic hypothermia program as well as strategies for changing clinical behavior. A team approach in terms of recruiting members to work together as well as emphasizing various methods for cooling were discussed. Based on the information presented during this roundtable discussion, it is clear that therapeutic hypothermia is being used, and a growing number of different types of caregivers are responsible for the successful implementation of the programs and beneficial results.Question: When you were going over your talk, some of your inclusion criteria were witnessed cardiac arrest, and it included VFib and pulseless VTach. I just recently rewrote the order sets for all seven of our hospitals. I removed that as an inclusion criterion because I didn't want to come across a physician who says, ''Oh, it is a pulseless electrical activity (PEA) and now we have ROSC [return of spontaneous circulation],'' but that didn't meet the criteria. So I am curious as to why you have VFib (VF) and pulseless VTach (VT) other than that's what the literature supports.Ms. Deborah Klein: When working with new hospitals that have never used therapeutic hypothermia before, I have found it easier to start off with the things that are very clear and are supported by the American Heart Association/ American College of Cardiology (AHA/ACC) guidelines. We include in our protocol to consider therapeutic hypothermia for asystole, PEA, and for in-hospital cardiac arrest. We don't want to limit therapeutic hypothermia to just the patients we know benefit (witness...