Rittenberger et al developed a severity score for predicting the outcome after a cardiac arrest. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Pittsburgh.
Patient selection: cardiac arrest
Outcome: survival, with good outcome being discharge home or for acute rehibilitation (CPC 1 or 2)
Parameters in the first 6 hours after the arrest in the absence of sedation or paralysis:
(1) Full Outline of UnResponsiveness (FOUR) brainstem subscore from 0 to 4
(2) Full Outline of UnResponsiveness (FOUR) motor subscore from 0 to 4
(3) SOFA cardiac subscale (hypotension) from 0 to 4
(4) SOFA respiratory subscale (PaO2 to FIO2 ratio) from 0 to 4
(5) level of consciousness (awake vs coma, LOC)
FOUR axis =
= (brainstem subscore) + (motor subscore)
SOFA axis =
= (cardiac subscale) + (respiratory subscale)
Interpretation:
• minimum FOUR or SOFA axis: 0
• maximum FOUR or SOFA axis: 8
• The higher the FOUR axis the better the patient status.
• The lower the SOFA axis the better the patient axis
|
LOC
|
FOUR axis
|
SOFA axis
|
Category (Outcome)
|
|
awake
|
8
|
NA
|
1, 80% survival, 60% good
|
|
coma
|
4 to 7
|
0 to 3
|
2, 60% survival, 40% good
|
|
coma
|
4 to 7
|
4 to 8
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3, 40% survival, 20% good
|
|
coma
|
0 to 3
|
NA
|
4, 10% survival, 5% good
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