Abstract 78: Modified Rankin Score at Hospital Discharge Is Predictive of 1-Year Neurological Function in Survivors After Cardiac Arrest
Background: A randomized multicenter clinical trial compared standard CPR (S-CPR) with active compression decompression CPR plus an inspiratory impedance threshold device (ACD+ITD) in patients with non-traumatic, out-of- hospital cardiac arrest (OHCA) from a presumed cardiac cause. Survival to hospital discharge (HD) with favorable neurologic function, defined as a modified Rankin Score (MRS) ≤3, and one year survival were greater in the ACD+ITD group. We evaluated the concordance of the primary endpoint, HD with MRS ≤3, with multiple secondary neurologic endpoints assessed at one year.
Methods: A total of 813 patients were enrolled in the S-CPR group and 842 in the ACD+ITD group. MRS at HD, and Cerebral Performance Category (CPC), Overall Performance Category (OPC), Health Utilities Index (HUI) and Cognitive Abilities Screening Instrument (CASI) assessments were based on responses from consented survivors and known deaths at one year. Neurologic assessments were administered by research staff blinded to the CPR treatment. Survival data were available for 98% of subjects. Fisher’s Exact Test, Pearson Chi-Square test, Mann-Whitney U test, and t-test for Equality of Means were used, as applicable, for comparisons. All statistical tests were 2-sided and p-values < 0.05 were regarded as significant.
Results: The MRS (≤3 vs. >3) neurological assessment at HD was highly predictive of whether or not a patient would be alive with favorable neurological function in both study groups, assessed using the CPC score (<3 vs. ≥3) at one year (98.0% observed agreement, kappa = 0.800, p < 0.001). Similar concordance was also shown with overall survival, OPC, HUI, CASI. Table shows data for MRS and CPC comparisons.
Conclusion: Neurological status at the time of HD, as measured by MRS, is highly predictive of long-term neurological function at one year. This is the first time that the MRS at the time of HD has demonstrated the ability to predict long-term outcomes for patients with OHCA.
- © 2012 by American Heart Association, Inc.