Clinical paperAn early, novel illness severity score to predict outcome after cardiac arrest☆
Introduction
The treatment of a patient with restoration of spontaneous circulation (ROSC) after cardiac arrest has evolved significantly. In particular, the syndrome of post-cardiac arrest illness has been described as consisting of several distinct, pathophysiological changes.1 Severity of illness is an important determinant of the response to therapeutic interventions. Classifying post-cardiac arrest patients with historical features, such as initial cardiac rhythm, or event-related features, such as witnessed collapse or location of collapse, is a surrogate for the physiological state of the patient. These classifications suffer from modest reliability2 and weak association with in-hospital clinical course.3 While several illness severity scores have been developed for critically ill patients, prior scores for post-cardiac arrest patients rely on some event-related data.4, 5 Data obtained after ROSC and prior to reaching target temperature were used to stratify post-cardiac arrest patients into clinically meaningful illness severity categories. Such categories permit tailoring of therapy for post-arrest patients. Rates of survival, neurologic outcome and development of multiple organ failure (MOF) are presented for each category.
Section snippets
Methods
This study was approved by the University of Pittsburgh Institutional Review Board. Subjects did not provide written informed consent for this study as these data are part of an ongoing quality assurance/quality improvement initiative in our facility.
Results
Of 495 subjects treated during this time period, 457 had valid data for analysis. Excluded subjects (N = 38) more frequently experienced IHCA, were comatose, and were treated in 2008 (corresponding to a loss of data during the change in electronic medical record systems for the ICU; p < 0.05). Excluded subjects less frequently experienced a primary rhythm of VF/VT, received TH, and received coronary angiography (p < 0.05) (Table 1).
The proportion of comatose subjects in categories II and III
Discussion
This study identified four distinct categories of post-cardiac arrest illness severity based on neurological dysfunction combined with cardiopulmonary dysfunction during the first few hours after ROSC. Survival, good outcome, and MOF varied greatly between categories, and the proportions of patients in different categories varied over time. The present results emphasize that illness severity should be carefully measured and accounted for in future studies of therapies.
The category of early
Conclusions
Initial illness severity explains much of the variation in cardiac arrest outcomes. This model provides prognostic information at hospital arrival and a universal nomenclature to stratify patients in future studies.
Conflicts of interest statement
The authors have no relevant conflicts of interest to report.
Acknowledgements
JCR and this project are supported by Grant Number 1 KL2 RR024154 from the National Center for Research Resources. The content is solely the responsibility of the authors and do not necessarily represent the official views of the NCRR or the National Institutes of Health. JCR is also supported by an unrestricted grant from the National Association of EMS Physicians/Zoll EMS Resuscitation Research Fellowship.
The authors also would like to acknowledge Dr. Garrick Kwok for his assistance in chart
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2022, Resuscitation PlusCitation Excerpt :The significant difference in motor exam between the survivors and non-survivors was seen starting on the first day after ROSC persists. This supports prior work demonstrating that initial illness severity is strongly associated with survival.11,14 However, we do note that survivorship is possible even in those with no motor response on Day 1, supporting prior work cautioning against early prognostication in this patient group.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.06.024.