Score of Longstreth et al for Prediction of Awakening Following Cardiac Arrest Outside of the Hospital

 

Criteria:

(1) included: ventricular fibrillation or asystole documented on ECG at scene of arrest

(2) excluded: global brain ischemia, cardiac rhythms giving brain perfusion

(3) awakening = either ability to follow commands or to speak comprehensibly

 

Parameters:

(1) motor response to physical stimulus

(2) pupillary light response

(3) spontaneous eye movements

(4) blood glucose on admission

 

Parameter	Finding	Points
motor response	absent	0
	extensor posturing	1
	flexor posturing	2
	nonposturing	3
	withdrawal or localizing	4
pupillary light response	absent	0
	present	1
spontaneous eye movements	absent	0
	present	1
blood glucose level on admission	>= 300 mg/dL	0
	< 300 mg/dL	1

 

prediction of awakening score =

= (points for motor response) + (3 * (points for pupillary light response)) + (points for spontaneous eye movements) + (points for blood glucose)

 

Interpretation:

• minimum score: 0

• maximum score: 9

 

Points	Percent Who Awakened
0, 1, 2	5%
3, 4	24%
5, 6, 7	74%
8, 9	95%

 

Performance of score:

• sensitivity 92%, specificity 65%

• positive predictive value 80%, negative predictive value 84%

• Of those predicted to recover but who did not, many had an additional cardiac arrest after admission to the hospital or developed another complication.

• Of those predicted not to awaken but who did, many had a severe neurologic deficit, but some were able to return to the functional level seen before the arrest.