Clinical paper|Articles in Press

Predicting the probability of survival with mild or moderate neurological dysfunction after in-hospital cardiopulmonary arrest: The GO-FAR 2 score



      The Good Outcome Following Attempted Resuscitation (GO-FAR) Score uses pre-arrest factors to predict survival after In-Hospital Cardiac Arrest (IHCA) with minimal neurological dysfunction, (cerebral performance category (CPC) ≤1). Moderate neurological dysfunction (CPC ≤2) may be a more acceptable outcome.


      To predict survival after IHCA with mild or moderate neurological dysfunction based on pre-arrest factors.


      52,468 patients with IHCA from 2012-2017. Data was divided into training (44%), testing (22%), and validation (34%) sets. Univariate analysis was used to identify variables with >3% difference in survival with CPC ≤2. These variables carried forward to the multivariate logistic regression model. The most parsimonious model that best classified patients as having a very poor (≤5%), below average (≤10%), average (11%–30%), or above average (>30%) likelihood of survival with CPC ≤2 was chosen.


      Age >85, admission CPC <2, and non-surgical admission were strongly association with poor survival (−12.1%, −14.4%, and −18%, respectively). Nine variables were included in the logistic regression analysis. The final updated model, GO FAR 2, categorized 6.2% of patients with a very poor predicted survival, 24.8% of patients with a below average predicted survival, and 11.3% with above average predicted survival. The observed survival among those with very poor predicted survival was 4.5%.


      The GO FAR 2 score provides clinicians with a prognostic estimate of the likelihood of a good outcome after IHCA based on pre-arrest patient factors. Future research is required to validate the GO-FAR 2 score.


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        • Merchant R.M.
        • Yang L.
        • Becker L.B.
        • et al.
        Incidence of treated cardiac arrest in hospitalized patients in the United States.
        Crit Care Med. 2011; 39: 2401-2406
        • Morrison L.J.
        • Neumar R.W.
        • Zimmerman J.L.
        • et al.
        Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association.
        Circulation. 2013; 127: 1538-1563
        • Kazaure H.S.
        • Roman S.A.
        • Sosa J.A.
        Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000–2009.
        Resuscitation. 2013; 84: 1255-1260
        • Girotra S.
        • Nallamothu B.K.
        • Spertus J.A.
        • Li Y.
        • Krumholz H.M.
        • Chan P.S.
        Trends in survival after in-hospital cardiac arrest.
        N Engl J Med. 2012; 367: 1912-1920
        • Fetters M.D.
        • Danis M.
        Death with Dignity: Cardiopulmonary Resuscitation in the United States and Japan.
        Springer, Dordrecht2002: 145-163
        • Fritz Z.
        • Slowther A.M.
        • Perkins G.D.
        Resuscitation policy should focus on the patient, not the decision.
        BMJ. 2017; 356: j813
        • Yuen J.K.
        • Reid M.C.
        • Fetters M.D.
        Hospital do-not-resuscitate orders: why they have failed and how to fix them.
        J Gen Intern Med. 2011; 26: 791-797
        • Hakim R.B.
        • Teno J.M.
        • Harrell F.E.
        • et al.
        Factors associated with do-not-resuscitate orders: patients’ preferences, prognoses, and physicians’ judgments. Support investigators. Study to understand prognoses and preferences for outcomes and risks of treatment.
        Ann Intern Med. 1996; 125: 284-293
        • Hofmann J.C.
        • Wenger N.S.
        • Davis R.B.
        • et al.
        Patient preferences for communication with physicians about end-of-life decisions. Support investigators. Study to understand prognoses and preference for outcomes and risks of treatment.
        Ann Intern Med. 1997; 127: 1-12
        • Golin C.E.
        • Wenger N.S.
        • Liu H.
        • et al.
        A prospective study of patient-physician communication about resuscitation.
        J Am Geriatr Soc. 2000; 48: S52-60
        • Ebell M.H.
        • Jang W.
        • Shen Y.
        • Geocadin R.G.
        Get with the Guidelines–Resuscitation investigators. Development and validation of the good outcome following attempted resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation.
        JAMA Intern Med. 2013; 173: 1872
        • Ohlsson M.A.
        • Kennedy L.M.
        • Ebell M.H.
        • Juhlin T.
        • Melander O.
        Validation of the good outcome following attempted resuscitation score on in-hospital cardiac arrest in southern Sweden.
        Int J Cardiol. 2016; 221: 294-297
        • Ebell M.H.
        • Afonso A.M.
        Pre-arrest predictors of failure to survive after in-hospital cardiopulmonary resuscitation: a meta-analysis.
        Fam Pract. 2011; 28: 505-515
        • van Gijn M.S.
        • Frijns D.
        • van de Glind E.M.M.
        • van Munster B.C.
        • Hamaker M.E.
        The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review.
        Age Ageing. 2014; 43: 456-463
        • Peberdy M.A.
        • Kaye W.
        • Ornato J.P.
        • et al.
        Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation.
        Resuscitation. 2003; 58: 297-308
        • Thompson L.E.
        • Chan P.S.
        • Tang F.
        • et al.
        Long-term survival trends of medicare patients after in-hospital cardiac arrest: insights from get with the Guidelines-Resuscitation®.
        Resuscitation. 2018; 123: 58-64
        • Cummins R.O.
        • Chamberlain D.
        • Hazinski M.F.
        • et al.
        Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital “Utstein style”. American Heart Association.
        Circulation. 1997; 95: 2213-2239
        • Stiell I.G.
        • Nesbitt L.P.
        • Nichol G.
        • et al.
        Comparison of the cerebral performance category score and the health utilities index for survivors of cardiac arrest.
        Ann Emerg Med. 2009; 53 (241-248.e1)
        • Vaahersalo J.
        • Hiltunen P.
        • Tiainen M.
        • et al.
        Therapeutic hypothermia after out-of-hospital cardiac arrest in finnish intensive care units: the FINNRESUSCI study.
        Intensive Care Med. 2013; 39: 826-837
        • Dragancea I.
        • Rundgren M.
        • Englund E.
        • Friberg H.
        • Cronberg T.
        The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest.
        Resuscitation. 2013; 84: 337-342
        • Lundbye J.B.
        • Rai M.
        • Ramu B.
        • et al.
        Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non-shockable rhythms.
        Resuscitation. 2012; 83: 202-207
        • Edgren E.
        • Hedstrand U.
        • Kelsey S.
        • Sutton-Tyrrell K.
        • Safar P.
        Assessment of neurological prognosis in comatose survivors of cardiac arrest. BRCT I study group.
        Lancet (London, England). 1994; 343: 1055-1059
        • Chan P.S.
        • Krein S.L.
        • Tang F.
        • et al.
        Resuscitation practices associated with survival after in-hospital cardiac arrest.
        JAMA Cardiol. 2016; 1: 189
        • Ebell M.H.
        • Becker L.A.
        • Barry H.C.
        • Hagen M.
        Survival after in-hospital cardiopulmonary resuscitation. A meta-analysis.
        J Gen Intern Med. 1998; 13: 805-816
        • McGrath R.B.
        In-house cardiopulmonary resuscitation–after a quarter of a century.
        Ann Emerg Med. 1987; 16: 1365-1368
        • Dautzenberg P.L.J.
        • Broekman T.C.J.
        • Hooyer C.
        • Schonwetter R.S.
        • Duursma S.A.
        Review: patient-related predictors of cardiopulmonary resuscitation of hospitalized patients.
        Age Ageing. 1993; 22: 464-475
        • Tibshirani R.
        Regression shrinkage and selection via the Lasso.
        J R Stat Soc Ser B. 1996; 58: 267-288
        • Umbach D.M.
        • Wilcox A.J.
        A technique for measuring epidemiologcally useful features of birthweight distrubutions.
        Stat Med. 1996; 15: 1333-1348
        • Christakis N.A.
        • Iwashyna T.J.
        Attitude and self-reported practice regarding prognostication in a National sample of internists.
        Arch Intern Med. 1998; 158: 2389
        • Eliasson A.H.
        • Parker J.M.
        • Shorr A.F.
        • et al.
        Impediments to writing do-not-resuscitate orders.
        Arch Intern Med. 1999; 159: 2213-2218
        • Ebell M.H.
        • Bergus G.R.
        • Warbasse L.
        • Bloomer R.
        The inability of physicians to predict the outcome of in-hospital resuscitation.
        J Gen Intern Med. 1996; 11: 16-22
        • Miller D.L.
        • Gorbien M.J.
        • Simbartl L.A.
        • Jahnigen D.W.
        Factors influencing physicians in recommending in-hospital cardiopulmonary resuscitation.
        Arch Intern Med. 1993; 153: 1999-2003
        • Ebell M.H.
        Prearrest predictors of survival following in-hospital cardiopulmonary resuscitation: a meta-analysis.
        J Fam Pract. 1992; 34: 551-558
        • George A.L.
        • Folk B.P.
        • Crecelius P.L.
        • Campbell W.B.
        Pre-arrest morbidity and other correlates of survival after in-hospital cardiopulmonary arrest.
        Am J Med. 1989; 87: 28-34
        • El-Jawahri A.
        • Mitchell S.L.
        • Paasche-Orlow M.K.
        • et al.
        A randomized controlled trial of a CPR and intubation video decision support tool for hospitalized patients.
        J Gen Intern Med. 2015; 30: 1071-1080
        • Murphy D.J.
        • Burrows D.
        • Santilli S.
        • et al.
        The influence of the probability of survival on patients’ preferences regarding cardiopulmonary resuscitation.
        N Engl J Med. 1994; 330: 545-549
        • White D.B.
        • Braddock C.H.
        • Bereknyei S.
        • Curtis J.R.
        Toward shared decision making at the end of life in intensive care units.
        Arch Intern Med. 2007; 167: 461
        • Schonwetter R.S.
        • Walker R.M.
        • Kramer D.R.
        • Robinson B.E.
        Resuscitation decision making in the elderly: the value of outcome data.
        J Gen Intern Med. 1993; 8: 295-300
        • Piscator E.
        • Göransson K.
        • et al.
        Predicting neurologically intact survival after in-hospital cardiac arrest-external validation of the good outcome following attempted resuscitation score.
        Resuscitation. 2018; 128: 63-69
        • Chan P.S.
        • Krein S.L.
        • Tang F.
        • et al.
        Resuscitation practices associated with survival after in-hospital cardiac arrest: a nationwide survey.
        JAMA Cardiol. 2016; 1: 189-197
        • Idris A.H.
        • Guffey D.
        • et al.
        Resuscitation outcomes consortium I: relationship between chest compression rates and outcomes from cardiac arrest.
        Circulation. 2012; 125: 3004-3012