Martinell et al reported early predictors of a poor outcome following an out-of-hospital cardiac arrest (OOHCA). These can help to identify a patient who may require more aggressive management. The authors are from the University of Gothenburg in Sweden with data from the Target Temperature Management trial.
Patient selection: 0ut-of-hospital cardiac arrest
Poor outcome: Cerebral Performance Category at 6 months 3-5
Predictors of a poor outcome:
(1) age
(2) cardiac arrest at home
(3) initial rhythm
(4) duration of no flow (time from arrest to start of CPR in minutes)
(5) duration of low flow (time from start of CPR to spontaneous circulation in minutes)
(6) administration of epinephrine (adrenaline)
(7) bilateral corneal and pupillary reflexes
(8) motor response for Glasgow coma scale (from 1 to 6)
(9) arterial pH
(10) arterial PCO2 at hospital admission in kPa
|
Parameter |
Finding |
Points |
|
age |
< 40 |
-1 |
|
|
40 to 44 |
0 |
|
|
45 to 49 |
1 |
|
|
50 to 54 |
2 |
|
|
55 to 59 |
3 |
|
|
60 to 64 |
4 |
|
|
65 to 69 |
5 |
|
|
70 to 74 |
6 |
|
|
75 to 79 |
7 |
|
|
80 to 84 |
8 |
|
|
>= 85 |
9 |
|
arrest at home |
no |
0 |
|
|
yes |
2 |
|
first monitored rhythm |
ventricular tachycardia or fibrillation |
0 |
|
|
other |
4 |
|
no flow |
0 to 4 minutes |
0 |
|
|
5 to 9 minutes |
1 |
|
|
10 to 14 minutes |
2 |
|
|
>= 15 minutes |
3 |
|
low flow |
0 to 5 minutes |
0 |
|
|
6 to 15 minutes |
1 |
|
|
16 to 30 minutes |
2 |
|
|
31 to 60 minutes |
3 |
|
|
> 60 minutes |
4 |
|
therapy with epinephrine |
no |
0 |
|
|
yes |
2 |
|
anypupillary or corneal reflex |
yes |
0 |
|
|
no |
3 |
|
arterial pH |
>= 7.35 |
-1 |
|
|
7.20 to 7.34 |
0 |
|
|
7.05 to 7.19 |
1 |
|
|
6.90 to 7.04 |
2 |
|
|
< 6.9 |
3 |
|
GCS motor |
1 |
2 |
|
|
2 to 6 |
0 |
|
PaCO2 |
>= 4.5 kPa |
0 |
|
|
< 4.5 kPa |
3 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -2
• maximum score: 35
• A score > 16 is high risk for a poor outcome.
Performance:
• The area under the ROC curve is 0.82 (corrected for optimism).
Specialty: Cardiology
