Nishikimi et al reported a score for predicting the severity of the neurological outcome in a pediatric patient who has had a cardiac arrest. This can help to identify a patient who has a poor prognosis and who may require more aggressive management. The first author is from Nagoya University in Japan.
rCAST = revised post-cardiac arrest syndrome for therapeutic hypothermia score
Patient selection: pediatric patient who has had an out-of-hospital cardiac arrest
Outcome: neurological at 30 and 90 days; a PCPC score of 1 or 2 was good and a score of 3 to 6 is poor.
Parameters:
(1) initial rhythm
(2) return of spontaneous circulation (ROSC) time in minutes or unwitnessed
(3) arterial pH
(4) blood lactate in mmol/L
(5) Glasgow coma scale motor score, from 1 to 6
Parameter
Finding
Points
initial rhythm
shockable
0
nonshockable
1
ROSC or witnessed
unwitnessed
4
< 20 minutes
0
>= 20 minutes
2
arterial pH
>= 7.31
0
7.16 to 7.31
2.5
7.01 to 7.15
5.0
<= 7.0
7.5
blood lactate
<= 5.0 mmol/L
0
5.1 to 10
0.5
10.1 to 14
1.0
> 14 mmol/L
1.5
GCS motor
1
4.5
2 to 6
0
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 18.5
rCAST Score
Severity
Good Outcome at 30 Days
0 to 6
low
100%
6 to 14.5
moderate
36%
14.5 to 18.5
high
2%
Performance:
• The area under the ROC curve is 0.95.
To read more or access our algorithms and calculators, please log in or register.
