背景:院外心脏骤停(OHCA)是一种具有多种起源和预后的异质实体。很早,可靠的预后评估有助于适应治疗策略,量身定制的护理强度,并通知亲戚。我们的主要目的是进行一项前瞻性多中心研究,以评估心脏骤停预后(CAHP)评分的预测性能,与OHCA(Utstein风格标准)后系统收集的历史数据集进行比较。我们的次要目的是评估OHCA后预测结果的其他专用分数,并将其与Utstein风格标准进行比较。
方法:我们在2020年8月至2022年6月期间从24个法国和比利时重症监护病房(ICU)收集了数据。纳入所有非创伤性OHCA(心脏和非心脏原因)患者,其在ICU入院时自发循环稳定恢复(ROSC)和昏迷(由格拉斯哥昏迷评分≤8定义)。主要结果是心脏骤停后第90天的改良Rankin量表(mRS),通过电话采访评估。广泛的发达分数(CAHP,OHCA,CREST,C-Graph,TTM,CAST,NULL-PLEASE,和MIRACLE2)被包括在内,以及它们在OHCA(定义为mRS≥4)后90天预测不良结局的准确性是使用接收工作特征曲线(AUROC)下面积和校准带确定的.
结果:在研究期间,907名患者进行了筛查,658例纳入研究.患者主要为男性(72%),平均年龄为61±15岁,大多数人由于假定的心脏原因而崩溃(64%)。第90天的死亡率为63%,神经系统不良结局为66%。Utstein不良结局预测标准的表现(AUROC)为0.79[0.76-0.83],而其他评分的AUROC从0.79[0.75-0.83]到0.88[0.86-0.91]不等。对于每个分数,无法计算个体值的患者比例从1.4%到17.4%不等.
结论:在OHCA成功复苏后进入ICU的患者中,大多数可用于评估后续预后的评分比通常的Utstein标准更有效,但其中一些评分的校正是不可接受的.我们的结果表明,一些分数(CAHP,sCAHP,mCAHP,OHCA,RCAST)具有优越的性能,他们的轻松和决心的速度应该鼓励他们的使用。试用注册https://clinicaltrials.gov/ct2/show/NCT04167891。
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a heterogeneous entity with multiple origins and prognoses. An early, reliable assessment of the prognosis is useful to adapt therapeutic strategy, tailor intensity of care, and inform relatives. We aimed primarily to undertake a prospective multicentric
study to evaluate predictive performance of the Cardiac Arrest Prognosis (CAHP) Score as compare to historical dataset systematically collected after OHCA (Utstein style criteria). Our secondary aim was to evaluate other dedicated scores for predicting outcome after OHCA and to compare them to Utstein style criteria.
METHODS: We prospectively collected data from 24 French and Belgium Intensive Care Units (ICUs) between August 2020 and June 2022. All cases of non-traumatic OHCA (cardiac and non-cardiac causes) patients with stable return of spontaneous circulation (ROSC) and comatose at ICU admission (defined by Glasgow coma score ≤ 8) on ICU admission were included. The primary outcome was the modified Rankin scale (mRS) at day 90 after cardiac arrest, assessed by phone interviews. A wide range of developed scores (CAHP, OHCA, CREST, C-Graph, TTM, CAST, NULL-PLEASE, and MIRACLE2) were included, and their accuracies in predicting poor outcome at 90 days after OHCA (defined as mRS ≥ 4) were determined using the area under the receiving operating characteristic curve (AUROC) and the calibration belt.
RESULTS: During the
study period, 907 patients were screened, and 658 were included in the
study. Patients were predominantly male (72%), with a mean age of 61 ± 15, most having collapsed from a supposed cardiac cause (64%). The mortality rate at day 90 was 63% and unfavorable neurological outcomes were observed in 66%. The performance (AUROC) of Utstein criteria for poor outcome prediction was moderate at 0.79 [0.76-0.83], whereas AUROCs from other scores varied from 0.79 [0.75-0.83] to 0.88 [0.86-0.91]. For each score, the proportion of patients for whom individual values could not be calculated varied from 1.4% to 17.4%.
CONCLUSIONS: In patients admitted to ICUs after a successfully resuscitated OHCA, most of the scores available for the evaluation of the subsequent prognosis are more efficient than the usual Utstein criteria but calibration is unacceptable for some of them. Our results show that some scores (CAHP, sCAHP, mCAHP, OHCA, rCAST) have superior performance, and that their ease and speed of determination should encourage their use.
Trial registration https://clinicaltrials.gov/ct2/show/NCT04167891.