Elsevier

Resuscitation

Volume 156, November 2020, Pages 167-173
Resuscitation

Clinical paper
OHCA (Out-of-Hospital Cardiac Arrest) and CAHP (Cardiac Arrest Hospital Prognosis) scores to predict outcome after in-hospital cardiac arrest: Insight from a multicentric registry

https://doi.org/10.1016/j.resuscitation.2020.09.021Get rights and content

Abstract

Aim

We assessed the ability of the Out-of-Hospital Cardiac Arrest (OHCA) and the Cardiac Arrest Hospital Prognosis (CAHP) scores to predict neurological outcome following in-hospital cardiac arrest (IHCA).

Methods

Retrospective review of a seven-year French multicentric database including ten intensive care units. Primary endpoint was the outcome at hospital discharge using the Cerebral Performance Category score (CPC) in all IHCA patients. OHCA and CAHP scores, sequential organ failure assessment (SOFA) score and the simplified acute physiological score 2 (SAPS-2) were compared using area under ROC curves (AUROC) and Delong tests.

Results

Among 381 included patients, 125 (33%) were discharged alive with favourable outcome (CPC 1–2). Among 256 patients (77%) with unfavourable outcome (CPC 3–5), 10 were discharged alive with CPC 3 (4%), 130 died from withdrawal of life sustaining therapies because of severe neurological impairment (51%), 107 died from multiorgan failure (42%) and 9 died after discharge from complications and comorbidities (3%). OHCA and CAHP scores were independently associated with unfavourable outcome. The AUROCs to predict unfavourable outcome for OHCA, CAHP, SAPS-2 and SOFA scores were 0.76 [0.70–0.80], 0.74 [0.69–0.79], 0.72 [0.67–0.77], and 0.69 [0.64–0.74] respectively, with a significant difference observed only between OHCA and SOFA scores AUROCs (p = 0.04).

Conclusion

In parallel with CAHP score, OHCA score could be used to early predict outcome at hospital discharge after IHCA. However, prediction accuracy for all scores remains modest, suggesting the use of other dedicated means to early predict IHCA patients’ outcome.

Introduction

Despite recent advance in resuscitation procedures and post cardiac arrest (CA) management, in-hospital cardiac arrest (IHCA) incidence remains high, with an estimated mortality rate of 10–25% and significant neurological impairment in survivors.1, 2, 3, 4, 5, 6, 7 Many physiological, clinical and biological parameters are identified as prognosis factors after IHCA occurrence.1, 8, 9, 10, 11, 12, 13, 14 Some outcome prediction scores calculated during or immediately after IHCA resuscitation attempts are proposed but with limited clinical application.15, 16, 17, 18 However, these models were tested on small or monocentric cohorts, included IHCA occurring in intensive care unit (ICU), operating room or in cath lab and excluded IHCA occurring in emergency department or in general wards (without patient’s continuous monitoring system). Finally, physicians need easy-to-obtain and reliable tools to early assess prognosis that could help them to optimize treatments. The Out-of-Hospital Cardiac Arrest (OHCA) score and the Cardiac Arrest Hospital Prognosis (CAHP) score have been proposed to evaluate the likelihood of poor outcome in patients admitted in ICU after out-of-hospital CA. These scores are based on easy-to-obtain data and showed a high performance for outcome prediction19, 20 with external validations.21, 22, 23

The aim of our study was to assess OHCA and CAHP scores ability to predict outcome in patients who were successfully resuscitated after an IHCA, compared with others general severity illness scores routinely used in ICU.

Section snippets

Study setting and population

We retrospectively reviewed the data of all unconscious (Glasgow coma scale ≤8) adult patients (≥18 years old), successfully resuscitated after an IHCA and admitted in ten French ICUs from January 2008 to December 2014. Patients with CA occurring in ICU, in operating room or in cath lab were excluded. Patients with missing data needed for OHCA or CAPH scores calculations were secondarily excluded. The ethical board of the French Intensive Care Society approved the study protocol (IRB N°14-36)

Patient characteristics

The flow chart of the study is described in Fig. 1. Among the 773 patients assessed for eligibility, 381 patients were finally analysed, with 125 patients (33%) being discharged alive from hospital with CPC 1−2. Among the 256 patients (77%) with unfavourable outcome, 10 were discharged alive with CPC 3 (4%), 130 died from withdrawal of life sustaining therapies because of severe neurological impairment (51%), 107 from multiorgan failure (42%) and 9 died after ICU discharge from complications

Discussion

To the best of our knowledge, this is the largest observational cohort evaluating the prognostic value of several severity scores including OHCA and CAHP scores in IHCA patients. In this population of IHCA occurring in general wards and emergency departments, our main findings can be summarized as follows: (1) OHCA and CAHP scores are independently associated with unfavourable outcome at hospital discharge; (2) The accuracy of OHCA and CAHP scores to early predict outcome remains moderate but

Conclusion

This study suggests OHCA and CAHP scores as simple and reliable tools to early predict neurological status at hospital discharge after IHCA. Although these scores seem superior to the others general severity of illness scoring systems (such as SAPS-2 and SOFA score), their moderate prediction accuracy suggests to propose another specific score dedicated for the early prediction of IHCA patient’s outcome.

Conflict of interest

None declared.

CRediT authorship contribution statement

Jonathan Chelly: Conceptualization, Methodology, Writing - original draft, Writing - review & editing, Visualization, Supervision, Project administration. Alain-Gil Mpela: Conceptualization, Data curation, Investigation, Writing - original draft, Writing - review & editing. Sebastien Jochmans: Formal analysis, Data curation, Project administration. Jennifer Brunet: Investigation. Stéphane Legriel: Investigation. Laurent Guerin: Investigation. Alexis Soummer: Investigation. Romain Persichini:

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