A Validated Prediction Tool for Initial Survivors of In-Hospital Cardiac Arrest

May 28, 2012
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Authors:
Chan PS, Spectus JA, Krumholz HM, et al., on behalf of the Get With the Guidelines–Resuscitation Registry Investigators.
Citation:
Arch Intern Med 2012;May 28:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

Can survival to hospital discharge without severe neurological impairment be accurately predicted in survivors of in-hospital cardiac arrest (IHCA)?

Methods:

Data were obtained from a prospective registry of IHCAs. The study subjects were 42,957 patients (mean age 62 years) who survived an IHCA. The primary study outcome was favorable neurological survival (FNS), defined as survival without severe neurological disability. Multiple variables were evaluated in two-thirds of the subjects to develop a prediction model for FNS. The model was validated in the remaining one-third of subjects.

Results:

The overall rate of FNS was 24.5%. The final prediction model included 11 variables independently associated with FNS. The strongest predictors were initial cardiac arrest rhythm, duration of resuscitation, and prearrest neurological status. A scoring system (Cardiac Arrest Survival Postresuscitation In-Hospital [CASPRI] score) based on the 11 variables was developed. A CASPRI score <10 was associated with a 71% probability of FNS, whereas a score ≥28 was associated with a 3% probability of FNS.

Conclusions:

The CASPRI score is a bedside prediction tool that is useful for estimating the odds of FNS after IHCA.

Perspective:

The prognostic information gained from the CASPRI score should prove useful in clinical practice for planning care and for discussions with patients and family members after an IHCA.

Keywords: Prognosis, Registries, Cardiopulmonary Resuscitation, Heart Arrest, Probability, Models, Theoretical, Patient Discharge


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