A Simple Risk Score for Predicting Neurologic Outcome in Out-of-Hospital Cardiac Arrest Patients After Targeted Temperature Management

Crit Care Med. 2022 Mar 1;50(3):428-439. doi: 10.1097/CCM.0000000000005266.

Abstract

Objectives: Although several risk factors for outcomes of out-of-hospital cardiac arrest patients have been identified, the cumulative risk of their combinations is not thoroughly clear, especially after targeted temperature management. Therefore, we aimed to develop a risk score to evaluate individual out-of-hospital cardiac arrest patient risk at early admission after targeted temperature management regarding poor neurologic status at discharge.

Design: Retrospective observational cohort study.

Setting: Two large academic medical networks in the United States.

Patients: Out-of-hospital cardiac arrest survivors treated with targeted temperature management with age of 18 years old or older.

Interventions: None.

Measurements and main results: Based on the odds ratios, five identified variables (initial nonShockable rhythm, Leucocyte count < 4 or > 12 K/μL after targeted temperature management, total Adrenalin [epinephrine] ≥ 5 mg, lack of oNlooker cardiopulmonary resuscitation, and Time duration of resuscitation ≥ 20 min) were assigned weighted points. The sum of the points was the total risk score known as the SLANT score (range 0-21 points) for each patient. Based on our risk prediction scores, patients were divided into three risk categories as moderate-risk group (0-7), high-risk group (8-14), and very high-risk group (15-21). Both the ability of our risk score to predict the rates of poor neurologic outcomes at discharge and in-hospital mortality were significant under the Cochran-Armitage trend test (p < 0.001 and p < 0.001, respectively).

Conclusions: The risk of poor neurologic outcomes and in-hospital mortality of out-of-hospital cardiac arrest survivors after targeted temperature management is easily assessed using a risk score model derived using the readily available information. Its clinical utility needed further investigation.

Trial registration: ClinicalTrials.gov NCT04217551.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Cardiopulmonary Resuscitation*
  • Cohort Studies
  • Female
  • Humans
  • Hypothermia, Induced / mortality*
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / mortality
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survivors / statistics & numerical data*
  • Time Factors
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT04217551