COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation

Abstract

Cardiac arrest effectiveness trials have traditionally reported outcomes that focus on survival. A lack of consistency in outcome reporting between trials limits the opportunities to pool results for meta-analysis. The COSCA initiative (Core Outcome Set for Cardiac Arrest), a partnership between patients, their partners, clinicians, research scientists, and the International Liaison Committee on Resuscitation, sought to develop a consensus core outcome set for cardiac arrest for effectiveness trials. Core outcome sets are primarily intended for large, randomised clinical effectiveness trials (sometimes referred to as pragmatic trials or phase III/IV trials) rather than for pilot or efficacy studies. A systematic review of the literature combined with qualitative interviews among cardiac arrest survivors was used to generate a list of potential outcome domains. This list was prioritised through a Delphi process, which involved clinicians, patients, and their relatives/partners. An international advisory panel narrowed these down to 3 core domains by debate that led to consensus. The writing group refined recommendations for when these outcomes should be measured and further characterised relevant measurement tools. Consensus emerged that a core outcome set for reporting on effectiveness studies of cardiac arrest (COSCA) in adults should include survival, neurological function, and health-related quality of life. This should be reported as survival status and modified Rankin scale score at hospital discharge, at 30 days, or both. Health-related quality of life should be measured with ≥1 tools from Health Utilities Index version 3, Short-Form 36-Item Health Survey, and EuroQol 5D-5L at 90 days and at periodic intervals up to 1 year after cardiac arrest, if resources allow. © 2018 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.

Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

“…Through the work of Core Outcome Set for Cardiac Arrest, there is a clear need for future research to address outcomes that are relevant and important to patient and their family such as quality of life and organ donation. [7,67]…”

“…[56,57] Future clinical trials should also include the critical outcome of long term survival with favourable neurological outcomes to address this research gap. [7] There was only one pilot randomised controlled study which reported only feasibility outcomes and did not demonstrate a difference between 30-day survival (CAC 9/18 50% vs other 6/15 40%) or 30day survival with favourable neurological outcome (CAC 9/18 50% vs other 7/14 50%). [30] This study has just started recruiting.…”

“…[6] Measures to maximise favourable neurological outcomes are a research priority for both patients and clinicians. [7] Post-resuscitation care, including percutaneous coronary intervention (PCI) and targeted temperature measurement (TTM), is an important component to achieve good neurological outcome. [8,9] In most countries, post resuscitation care is not regionalized to specialised hospitals.…”

The present and future of cardiac arrest care: international experts reach out to caregivers and healthcare authorities

“…Trials involving critically ill patients rarely measure patient-reported outcomes as the primary or secondary outcome measure (5 vs. 22%, respectively) [96]. Patients and their family members involved in the Core Outcomes Set for Cardiac Arrest (COSCA) process identified survival, neurological function and HRQoL as the preferred outcome measures [97]. To date, studies of post-discharge outcomes have provided conflicting evidence of the magnitude of impairment after cardiac arrest [15,86,98,99].…”

The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial

“…Analyses assessed the primary outcome: survival at 30 days, and secondary outcomes: survival at discharge, ROSC at hospital admission and neurological outcome at discharge from hospital. The neurological outcome was measured using a modified Rankin scale (mRS) assessment [ranging from 0 (no symptoms) to 6 (death)] where a score of 0-3 inclusive was considered favourable [14].…”