Rabinstein et al developed a score for predicting death from cardiac arrest following discontinuation of life support in a patient in a neurocritical state. This can help to evaluate a patient who will be an organ donor following death. The authors are from the Mayo Clinic, the Univesity of California San Francisco, Erasmus MC University Medical Center, University of Cincinnati and Washington University in St Louis.
Patient selection: neurocritical state (stroke, subarachnoid hemorrhage, trauma, etc)
Outcome: cardiac arrest within 60 minutes
Parameters:
(1) corneal reflexes
(2) cough reflex
(3) motor response
(4) oxygenation index
oxygenation index =
= 100 * (FIO2 from 0.21 to 1.00) * (mean airway pressure in cm H2O) / (PaO2 in mm Hg)
Parameter
Finding
Points
corneal reflexes
present
0
absent
1
cough reflex
present
0
absent
2
motor response
extensor or absent
1
other
0
oxygenation index
<= 3
0
> 3
1
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the more likely that cardiac arrest will occur within 60 minutes.
Score
Percentage with Death within 60 minutes
0
5%
1
27%
2
29%
3
52%
4
80%
5
89%
Alternatively:
X =
= (0.9 if absent corneal reflex else 0) + (1.65 if cough reflex absent else 0) + (0.98 if extensor/absent motor response else 0) + (0.12 * (oxygenation index)) – 2.49
probability of death within 60 minutes =
= 1 / (1 + EXP((-1) * X))
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