Out-of-hospital cardiac arrest: A systematic review of current risk scores to predict survival

Gue, Ying X; Adatia, Krishma; Kanji, Rahim; Potpara, Tatjana; Lip, Gregory Y.H.; Gorog, Diana A.

doi:10.1016/j.ahj.2020.12.011

Cited by 28 publications

(18 citation statements)

References 33 publications

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“…In the past 15 years, several clinical risk scores have been developed and validated specifically for early prognostication after cardiac arrest [ 22 , 23 ]. Still, only a few have been adequately validated in independent cohorts [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

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

Blatter

Amacher

Bohren

et al. 2022

Ann. Intensive Care

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Background Several scoring systems have been used to predict short-term outcome in patients with out-of-hospital cardiac arrest (OHCA), including the disease-specific OHCA and CAHP (Cardiac Arrest Hospital Prognosis) scores, as well as the general severity-of-illness scores Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II). This study aimed to assess the prognostic performance of these four scores to predict long-term outcomes (≥ 2 years) in adult cardiac arrest patients. Methods This is a prospective single-centre cohort study including consecutive cardiac arrest patients admitted to intensive care in a Swiss tertiary academic medical centre. The primary endpoint was 2-year mortality. Secondary endpoints were neurological outcome at 2 years post-arrest assessed by Cerebral Performance Category with CPC 1–2 defined as good and CPC 3–5 as poor neurological outcome, and 6-year mortality. Results In 415 patients admitted to intensive care, the 2-year mortality was 58.1%, with 96.7% of survivors showing good neurological outcome. The 6-year mortality was 82.5%. All four scores showed good discriminatory performance for 2-year mortality, with areas under the receiver operating characteristics curve (AUROC) of 0.82, 0.87, 0.83 and 0.81 for the OHCA, CAHP, APACHE II and SAPS II scores. The results were similar for poor neurological outcome at 2 years and 6-year mortality. Conclusion This study suggests that two established cardiac arrest-specific scores and two severity-of-illness scores provide good prognostic value to predict long-term outcome after cardiac arrest and thus may help in early goals-of-care discussions.

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Section: Introductionmentioning

confidence: 99%

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

Blatter

Amacher

Bohren

et al. 2022

Ann. Intensive Care

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“…A recent systematic review by Gue et al[ 68 ] aimed to summarise available clinical risk scores and their performance in a similar way, but only included scores with survival as the predicted outcome, as the authors deemed neurological outcome to be too ambiguous [ 68 ]. Eleven scoring systems predicting mortality after OHCA were identified and their development, calculation and performance summarised briefly.…”

Section: Discussionmentioning

confidence: 99%

Predicting neurological outcome in adult patients with cardiac arrest: systematic review and meta-analysis of prediction model performance

et al. 2022

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This work aims to assess the performance of two post-arrest (out-of-hospital cardiac arrest, OHCA, and cardiac arrest hospital prognosis, CAHP) and one pre-arrest (good outcome following attempted resuscitation, GO-FAR) prediction model for the prognostication of neurological outcome after cardiac arrest in a systematic review and meta-analysis. A systematic search was conducted in Embase, Medline, and Web of Science Core Collection from November 2006 to December 2021, and by forward citation tracking of key score publications. The search identified 1′021 records, of which 25 studies with a total of 124′168 patients were included in the review. A random-effects meta-analysis of C-statistics and overall calibration (total observed vs. expected [O:E] ratio) was conducted. Discriminatory performance was good for the OHCA (summary C-statistic: 0.83 [95% CI 0.81–0.85], 16 cohorts) and CAHP score (summary C-statistic: 0.84 [95% CI 0.82–0.87], 14 cohorts) and acceptable for the GO-FAR score (summary C-statistic: 0.78 [95% CI 0.72–0.84], five cohorts). Overall calibration was good for the OHCA (total O:E ratio: 0.78 [95% CI 0.67–0.92], nine cohorts) and the CAHP score (total O:E ratio: 0.78 [95% CI 0.72–0.84], nine cohorts) with an overestimation of poor outcome. Overall calibration of the GO-FAR score was poor with an underestimation of good outcome (total O:E ratio: 1.62 [95% CI 1.28–2.04], five cohorts). Two post-arrest scores showed good prognostic accuracy for predicting neurological outcome after cardiac arrest and may support early discussions about goals-of-care and therapeutic planning on the intensive care unit. A pre-arrest score showed acceptable prognostic accuracy and may support code status discussions. Graphical Abstract

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“…Several other scores have been created as prognostic tools for patients after ROSC, including NULL-PLEASE, OHCA, and rCAST, each of which exhibit good predictive value (AUC >0.8) ( 12 ). However, these scores require variables not immediately attainable on arrival to the emergency department (e.g., serum lactate, pH level, cause of arrest) or variables that are subject to recall bias (e.g., duration of low-flow or no-flow time), or require complex calculations and a score calculator for interpretation.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review by Gue et al identified several existing OHCA prognostication risk scores with good predictive ability ( 12 ). However, the clinical relevance of these scores was noted to be limited by difficulty in computation, recall bias and unavailability of data at the time the patient is in the emergency department (ED).…”

Section: Introductionmentioning

confidence: 99%

External validation of the Survival After ROSC in Cardiac Arrest (SARICA) score for predicting survival after return of spontaneous circulation using multinational pan-asian cohorts

et al. 2022

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AimAccurate and timely prognostication of patients with out-of-hospital cardiac arrest (OHCA) who attain return of spontaneous circulation (ROSC) is crucial in clinical decision-making, resource allocation, and communication with family. A clinical decision tool, Survival After ROSC in Cardiac Arrest (SARICA), was recently developed, showing excellent performance on internal validation. We aimed to externally validate SARICA in multinational cohorts within the Pan-Asian Resuscitation Outcomes Study.Materials and methodsThis was an international, retrospective cohort study of patients who attained ROSC after OHCA in the Asia Pacific between January 2009 and August 2018. Pediatric (age <18 years) and traumatic arrests were excluded. The SARICA score was calculated for each patient. The primary outcome was survival. We used receiver operating characteristics (ROC) analysis to calculate the model performance of the SARICA score in predicting survival. A calibration belt plot was used to assess calibration.ResultsOut of 207,450 cases of OHCA, 24,897 cases from Taiwan, Japan and South Korea were eligible for inclusion. Of this validation cohort, 30.4% survived. The median SARICA score was 4. Area under the ROC curve (AUC) was 0.759 (95% confidence interval, CI 0.753–0.766) for the total population. A higher AUC was observed in subgroups that received bystander CPR (AUC 0.791, 95% CI 0.782–0.801) and of presumed cardiac etiology (AUC 0.790, 95% CI 0.782–0.797). The model was well-calibrated.ConclusionThis external validation study of SARICA demonstrated high model performance in a multinational Pan-Asian cohort. Further modification and validation in other populations can be performed to assess its readiness for clinical translation.

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Out-of-hospital cardiac arrest: A systematic review of current risk scores to predict survival

Cited by 28 publications

References 33 publications

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

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

Predicting neurological outcome in adult patients with cardiac arrest: systematic review and meta-analysis of prediction model performance

External validation of the Survival After ROSC in Cardiac Arrest (SARICA) score for predicting survival after return of spontaneous circulation using multinational pan-asian cohorts

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