Abstract 13428: A Scoring System for Early Prognostication of Neurologic Outcomes in Out-of-hospital Sudden Cardiac Arrest Treated With Mild Therapeutic Hypothermia
Background: Out of hospital sudden cardiac arrest (SCA) is highly fatal, with estimated survival to hospital discharge 10-37%. The leading cause of death is neurologic injury, but with mild therapeutic hypothermia (MTH), favorable neurologic outcomes (NO) improve by 20%. Current guidelines recommend delayed prognostication for 72 hours post-SCA; our study aims to determine if early quantitative stratification of NO can be made using data available at hospital presentation.
Methods: A retrospective chart review identified adult patients who received intravascular MTH for out of hospital SCA at a single institution from 2008-12 (n = 122). Patient demographics, pre-arrest diagnoses, resuscitation timing, and initial laboratory/imaging studies were compared between favorable and poor NO. As in landmark studies, favorable NO was defined as cerebral performance category (CPC) 1-2, poor 3-5. CPC assignment was made retrospectively by neurology using consultation and discharge physical exams. Univariate analysis was performed on all collected variables; those with ρ <0.1 were combined to create a multivariate model. Significant inputs from this model were retained and converted into categorical variables based on ROC cut points discriminating favorable from poor NO.
Results: 42 patients survived to hospital discharge (34%), 33 with favorable NO (27%). The final model included the following variables: age >45, CAD, non-VT/VF arrest, initial blood glucose >200, and initial pH <7.0. Assigning each variable 1 point, this scoring system has an AUC of 0.814 for predicting poor NO and provides good discrimination at hospital discharge with 100% favorable NO at a score of 0 (n = 3) and 0% at a score of ≥4 (n = 15).
Conclusions: This scoring system may allow for stratification of neurologic outcomes at hospital presentation and may identify a subset of patients who do not derive benefit from MTH and continued intensive care. Future multi-site, prospective investigation is needed.
- © 2013 by American Heart Association, Inc.