Performance of clinical risk scores to predict mortality and neurological outcome in cardiac arrest patients

Isenschmid, Cyril; Luescher, Tanja; Rasiah, Roshaani; Kalt, Jeanice; Tondorf, Theresa; Gamp, Martina; Becker, Christoph; Tisljar, Kai; Sutter, Raoul; Schuetz, Philipp; Hochstrasser, Seraina; Metzger, Kerstin; Marsch, Stephan; Hunziker, Sabina

doi:10.1016/j.resuscitation.2018.10.022

Cited by 41 publications

(38 citation statements)

References 18 publications

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“…The use of modified APACHE scores to correct for illness severity when examining the association between oxygenation and carbon dioxide and outcomes following cardiac arrest is well established [6,7,13,15] but not universally applied [4, 5, 7, 9-11, 16, 17]. The APACHE II score has previously been shown to have a similar ability to predict mortality following OHCA as the diseasespecific OHCA score [50].…”

Section: Discussionmentioning

confidence: 99%

The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study

et al. 2020

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Background: Outcomes following out of hospital cardiac arrest (OHCA) are poor. The optimal arterial oxygen and carbon dioxide (PaCO 2) levels for managing patients following OHCA are unknown. We hypothesized that abnormalities in arterial oxygenation (PaO 2 /FiO 2 ratio or PaO 2) and PaCO 2 would be associated with hospital mortality following OHCA. We hypothesized that PaCO 2 would significantly modify the oxygenation-mortality relationship. Methods: This was an observational cohort study using data from OHCA survivors admitted to adult critical care units in England, Wales and Northern Ireland from 2011 to 2018. Logistic regression analyses were performed to assess the relationship between hospital mortality and oxygenation and PaCO 2. Results: The analysis included 23,625 patients. In comparison with patients with a PaO 2 /FiO 2 > 300 mmHg, those with a PaO 2 /FiO 2 ≤ 100 mmHg had higher mortality (adjusted OR, 1.79; 95% CI, 1.48 to 2.15; P < 0.001). In comparison to hyperoxemia (PaO 2 > 100 mmHg), patients with hypoxemia (PaO 2 < 60 mmHg) had higher mortality (adjusted OR, 1.34; 95% CI, 1.10 to 1.65; P = 0.004). In comparison with normocapnia, hypercapnia was associated with lower mortality. Hypocapnia (PaCO2 ≤ 35 mmHg) was associated with higher mortality (adjusted OR, 1.91; 95% CI, 1.63 to 2.24; P < 0.001). PaCO 2 modified the PaO 2 /FiO 2-mortality and PaO 2-mortality relationships, though these relationships were complex. Patients who were both hyperoxic and hypercapnic had the lowest mortality. Conclusions: Low PaO 2 /FiO 2 ratio, hypoxemia and hypocapnia are associated with higher mortality following OHCA. PaCO 2 modifies the relationship between oxygenation and mortality following OHCA; future studies examining this interaction are required.

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Section: Discussionmentioning

confidence: 99%

The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study

et al. 2020

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“…The period between the time of arrest and the time of starting resuscitation is important to survival 8,17,20. Various studies have reported different times of starting resuscitation and survival outcomes 4.…”

Section: Discussionmentioning

confidence: 99%

Survival after cardiopulmonary arrest in a tertiary care hospital in Turkey

Yılmaz

Ömürlü

2019

Ann Saudi Med

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BACKGROUND Despite significant improvements in the field of cardiopulmonary resuscitation (CPR) over the past 40 years, disparate survival rates are reported after in-hospital cardiac arrest (IHCA). Few studies have addressed the effect of comorbid conditions on survival after IHCA. OBJECTIVE Examine IHCAs over a two-year period, determine survival rates, and assess the effects of comorbid diseases on survival after IHCA. DESIGN Retrospective, cross-sectional study. SETTINGS Tertiary care hospital in Turkey. PATIENTS AND METHODS Patients who had an IHCA recorded in the data management system between 1 January 2016 and 31 December 2017 were evaluated using Utstein-style records for data collection. The Charlson Comorbidity Index (CCI) was scored retrospectively. MAIN OUTCOME MEASURES Return of spontaneous circulation (ROSC), survival in the first 24 hours, survival longer than 24 hours, and survival up to 6 months after discharge, CCI score, gender, age, location of IHCA, and first documented heart rhythm. SAMPLE SIZE 370 IHCA cases. RESULTS Of 502 patient, 370 met inclusion criteria. The presence of shockable rhythm was low (15.7%). The CCI was ≤3 in 10% (n=37) of all patients. A CPR duration of ≥20 minutes was the most important risk factor for ROSC. CCI ≥6 reduced ROSC-achieved cases by 2.8-fold ( P =.036) and increased the mortality rate by 2.8 fold ( P =.041). IHCA was most frequent in intensive care units (60.3%, n=223). CONCLUSION Assessing patients at risk in the hospital for comorbid conditions by CCI would be beneficial to prevent deaths related to IHCA. Close monitoring of patients with high CCI scores is advisable, as is making IHCA calls on time. LIMITATIONS Retrospective, small sample size, and no evaluation of the neurological condition of the discharged patients.

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“…Patients or, in case of unconsciousness, a relative of theirs or a health care agent had to sign a consent form to participate in the study. Detailed information about the study has been published elsewhere [5,[20][21][22].…”

Section: Methodsmentioning

confidence: 99%

Low Plasma Sphingomyelin Levels Show a Weak Association with Poor Neurological Outcome in Cardiac Arrest Patients: Results from the Prospective, Observational COMMUNICATE Trial

Boerlin

Luescher

Becker

et al. 2020

JCM

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There is interest in novel blood markers to improve risk stratification in patients presenting with cardiac arrest. We assessed associations of different plasma sphingomyelin concentrations and neurological outcome in patients with cardiac arrest. In this prospective observational study, adult patients with cardiac arrest were included upon admission to the intensive care unit (ICU). We studied associations of admission plasma levels of 15 different sphingomyelin species with neurological outcome at hospital discharge (primary endpoint) defined by the modified Rankin Scale by the calculation of univariable and multivariable logistic regression models adjusted for age, gender, and clinical shock markers. We included 290 patients (72% males, median age 65 years) with 162 (56%) having poor neurological outcome at hospital discharge. The three sphingomyelin species SM C24:0, SM(OH) C22:1, and SM(OH) C24:1 were significantly lower in patients with poor neurological outcome compared to patients with favorable outcome with areas under the curve (AUC) of 0.58, 0.59, and 0.59. SM(OH) C24:1 was independently associated with poor neurological outcome in a fully-adjusted regression model (adjusted odds ratio per log-transformed unit increase in SM(OH) C24:1 blood level 0.18, 95% CI 0.04 to 0.87, p = 0.033). Results were similar for 1-year mortality. Low admission sphingomyelin levels showed a weak association with poor neurological outcome in patients after cardiac arrest. If validated in future studies, a better understanding of biological sphingomyelin function during cardiac arrest may help to further advance the therapeutic approach and risk stratification in this vulnerable patient group.

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Performance of clinical risk scores to predict mortality and neurological outcome in cardiac arrest patients

Cited by 41 publications

References 18 publications

The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study

The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study

Survival after cardiopulmonary arrest in a tertiary care hospital in Turkey

Low Plasma Sphingomyelin Levels Show a Weak Association with Poor Neurological Outcome in Cardiac Arrest Patients: Results from the Prospective, Observational COMMUNICATE Trial

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