Prognostic indicators and outcome prediction model for patients with return of spontaneous circulation from cardiopulmonary arrest: The Utstein Osaka Project

Hayakawa, Koichi; Tasaki, Osamu; Hamasaki, Toshimitsu; Sakai, Tomohiko; Shiozaki, Tadahiko; Nakagawa, Yuko; Ogura, Hiroshi; Kuwagata, Yasuyuki; Kajino, Kentaro; Iwami, Taku; Nishiuchi, Tatsuya; Hayashi, Yasuyuki; Hiraide, Atsushi; Sugimoto, Hisashi; Shimazu, Takeshi

doi:10.1016/j.resuscitation.2011.02.045

Cited by 58 publications

(42 citation statements)

References 28 publications

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“…The OHCA score was prospective and externally validated from 1999 to 2005 (composite n=340) with primary outcome CPC 1 to 2 at hospital discharge 19. The formula for score calculation is −13×(1 if VT/VF)+6×ln[time to CPR(min)] −1434/Cr(μmol/L)+10×ln(lactate(mmol/L), with higher scores predicting poor neurologic outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple models have previously been developed with the goal of earlier outcome stratification,18, 19, 20, 21 yet all are significantly limited by invalidity in TTM populations and/or weighting toward historically unreliable arrest timing variables (eg, time to return of spontaneous circulation [ROSC]) 22. There remains a need for a scoring system that can predict neurologic outcome after OHCA treated with TTM that is also (1) calculated early after hospital presentation; (2) comprised of reliable, objective data (no timing variables); (3) inclusive of all rhythms of arrest; and (4) easily applicable by varied subspecialty providers who routinely participate in post‐OHCA care.…”

Section: Introductionmentioning

confidence: 99%

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C‐GRApH : A Validated Scoring System for Early Stratification of Neurologic Outcome After Out‐of‐Hospital Cardiac Arrest Treated With Targeted Temperature Management

Kiehl

Parker

Matar

et al. 2017

JAHA

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

C‐GRApH : A Validated Scoring System for Early Stratification of Neurologic Outcome After Out‐of‐Hospital Cardiac Arrest Treated With Targeted Temperature Management

Kiehl

Parker

Matar

et al. 2017

JAHA

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“…43 Detailed models predicting outcomes after CA have been developed using prognostic indicators such as initial rhythm, estimated no-flow interval and low-flow interval, blood lactate, and creatinine levels at admission, as well as time from collapse to ROSC and the presence of ROSC under prehospital conditions, witnessed arrest, and administration of bystander CPR. 44,45 The value of risk-adjustment models that evaluate PCI in CA would increase substantially if such variables were included. The ongoing challenge is to better define the predictors of mortality in these critically ill patients so that data-driven outcome predictions can be made.…”

Section: Discussionmentioning

confidence: 99%

Impact of Percutaneous Coronary Intervention Performance Reporting on Cardiac Resuscitation Centers

Peberdy¹,

Donnino²,

Callaway³

et al. 2013

Circulation

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“…19 For OHCA of presumed cardiac origin, another model included variables such as age, time from collapse to ROSC, and ROSC prior to arrival at the hospital. 20 Summary Current evidence indicates which patients may not be good candidates for TTM, such as patients with a GWR ≤1.14 or rSO2 ≤40. EEG monitoring has also been used to estimate neurologic outcome.…”

Section: Cbf and Metabolismmentioning

confidence: 99%

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

Nakashima

Hifumi

Kawakita

et al. 2017

Circ J

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The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia. We reviewed the literature and the latest research about the following issues and propose practical care recommendations. Issues are (1) prediction of TTM candidate on admission, (2) cerebral blood flow and metabolism and target value of them, (3) seizure management using continuous electroencephalography, (4) target value of hemodynamic stabilization and its method, (5) management and analysis of respiration, (6) sedation and its monitoring, (7) shivering control and its monitoring, and (8) glucose management. We hope to establish standards of neurocritical care to optimize brain function and produce a favorable neurologic outcome.

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Prognostic indicators and outcome prediction model for patients with return of spontaneous circulation from cardiopulmonary arrest: The Utstein Osaka Project

Cited by 58 publications

References 28 publications

C‐GRApH : A Validated Scoring System for Early Stratification of Neurologic Outcome After Out‐of‐Hospital Cardiac Arrest Treated With Targeted Temperature Management

C‐GRApH : A Validated Scoring System for Early Stratification of Neurologic Outcome After Out‐of‐Hospital Cardiac Arrest Treated With Targeted Temperature Management

Impact of Percutaneous Coronary Intervention Performance Reporting on Cardiac Resuscitation Centers

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

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