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A Validated Prediction Tool for Initial Survivors of In-Hospital Cardiac Arrest
Study Questions:
What is the clinical utility of the CASPRI (Cardiac Arrest Survival Postresuscitation In-hospital) score among successfully resuscitated patients with an in-hospital cardiac arrest in predicting survival to hospital discharge without severe neurological deficits?
Methods:
Within the Get With the Guidelines–Resuscitation registry, the authors identified 42,957 patients from 551 hospitals admitted between January 2000 and October 2009 who were successfully resuscitated from an in-hospital cardiac arrest. A simple prediction tool for favorable neurological survival in patients successfully resuscitated from an in-hospital cardiac arrest was developed using multivariate logistic regression, with two-thirds of the sample randomly selected as the derivation cohort and one-third as the validation cohort. Favorable neurological status was defined as the absence of severe neurological deficits (cerebral performance category score of ≤2).
Results:
Rates of favorable neurological survival were similar in the derivation cohort (7,052 patients [24.6%]) and validation cohort (3,510 patients [24.5%]). Eleven variables were associated with favorable neurological survival: younger age, initial cardiac arrest rhythm of ventricular fibrillation or pulseless ventricular tachycardia with a defibrillation time of 2 minutes or less, baseline neurological status without disability, arrest location in a monitored unit, shorter duration of resuscitation, and absence of mechanical ventilation, renal insufficiency, hepatic insufficiency, sepsis, malignant disease, and hypotension prior to the arrest. The model had excellent discrimination (C statistic of 0.80 for both the derivation and validation cohorts) and calibration. The prediction tool demonstrated the ability to identify patients across a wide range of rates of favorable neurological survival: patients in the top decile had a 70.7% probability of this outcome, whereas patients in the bottom decile had a 2.8% probability.
Conclusions:
The authors concluded that among successfully resuscitated patients with an in-hospital cardiac arrest, a simple bedside prediction tool provides robust estimates of the probability of favorable neurological survival.
Perspective:
The investigators appear to have developed and validated a simple bedside prediction tool, the CASPRI score, which can be used to estimate the likelihood of survival to discharge with favorable neurological status for patients initially resuscitated from an in-hospital cardiac arrest. Given that this prediction tool was developed in over 40,000 patients from 551 hospitals and used clinical factors that can be readily assessed, it may offer physicians reliable and valuable prognostic information for discussions with patients and their families after successful resuscitation. Independent validation of this score in another cohort will further solidify its role.
Keywords: Calibration, Sepsis, Respiration, Artificial, Electric Countershock, Ventricular Fibrillation, Cardiopulmonary Resuscitation, Hypotension, Heart Arrest, Registries, Renal Insufficiency, Tachycardia, Ventricular, Hepatic Insufficiency, Heart Failure, Logistic Models
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