Review| Volume 151, P139-144, June 2020

Predictive value of hospital discharge neurological outcome scores for long-term neurological status following out-of-hospital cardiac arrest: A systematic review

  • Author Footnotes
    1 Co-first authors.
    Wen Wu
    Corresponding author at: Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada. Tel.: +1 613 261 6413.
    1 Co-first authors.
    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Author Footnotes
    1 Co-first authors.
    Amit Chopra
    1 Co-first authors.
    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Carolyn Ziegler
    Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
    Search for articles by this author
  • Author Footnotes
    2 Co-senior authors.
    Shelley L. McLeod
    2 Co-senior authors.
    Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada

    Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Author Footnotes
    2 Co-senior authors.
    Steve Lin
    2 Co-senior authors.
    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Author Footnotes
    1 Co-first authors.
    2 Co-senior authors.



      Neurological status following out-of-hospital cardiac arrest is commonly assessed using measures such as the Cerebral Performance Category (CPC) at hospital discharge. However, it remains unclear if these measures accurately reflect long-term neurological status after discharge. The objective of this systematic review was to determine the association between post-arrest neurological outcome scores at hospital discharge and long-term (>6 months) neurological outcome scores.


      Comprehensive database searches of Medline, Embase, and the Cochrane library databases from inception to August 2019 were conducted and reference lists were hand-searched. Randomized controlled trials (RCT) and prospective observational studies were included.


      After screening 7844 titles and abstracts independently and in duplicate, we included 7 studies with a total of 602 patients from 6 prospective observational studies and 1 RCT. Four studies reported long-term follow-up at 6 months post-arrest and three studies reported follow-up at 1 year. In the studies with 6-month follow-up, 368 patients (82.7%) had favorable short-term neurological scores (CPC 1–2) at discharge or 30 days post-arrest, and 352 patients (79.1%) had favorable scores at 6 months post-arrest. In the studies with 1-year follow-up, 101 patients (64.3%) had favorable neurological scores at discharge or 30 days post-arrest, and 91 patients (59.5%) patients had favorable neurological scores at 1 year.


      Long-term neurological outcome scores following OHCA were consistent with short-term outcome at hospital discharge or 30 days post-arrest. All included studies measured neurological outcome using CPC, further studies are needed using other standards to better elucidate patient-centered long-term neurological outcome.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Nichol G.
        • Thomas E.
        • Callaway C.W.
        • et al.
        Regional variation in out-of-hospital cardiac arrest incidence and outcome.
        JAMA. 2008; 300: 1423-1431
        • Laver S.
        • Farrow C.
        • Turner D.
        • Nolan J.
        Mode of death after admission to an intensive care unit following cardiac arrest.
        Intensive Care Med. 2004; 30: 2126-2128
        • Hossmann K.A.
        • Oschlies U.
        • Schwindt W.
        • Krep H.
        Electron microscopic investigation of rat brain after brief cardiac arrest.
        Acta Neuropathol (Berl). 2001; 101: 101-113
        • Neumar R.W.
        • Nolan J.P.
        • Adrie C.
        • et al.
        Post-cardiac arrest syndrome.
        Circulation. 2008; 118: 2452-2483
        • Hypothermia After Cardiac Arrest Study Group
        Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest [published correction appears in N Engl J Med. 2002;346:1756].
        N Engl J Med. 2002; 346: 549-556
        • Ajam K.
        • Gold L.S.
        • Beck S.S.
        • Damon S.
        • Phelps R.
        • Rea T.D.
        Reliability of the Cerebral Performance Category to classify neurological status among survivors of ventricular fibrillation arrest: a cohort study.
        Scand J Trauma Resusc Emerg Med. 2011; 19: 38
        • Raina K.D.
        • Callaway C.
        • Rittenberger J.C.
        • Holm M.B.
        Neurological and functional status following cardiac arrest: method and tool utility.
        Resuscitation. 2008; 79: 249-256
        • Naber D.
        • Bullinger M.
        Psychiatric sequelae of cardiac arrest.
        Dialogues Clin Neurosci. 2018; 20: 73-77
        • Kida K.
        • Ichinose F.
        Preventing ischemic brain injury after sudden cardiac arrest using NO inhalation.
        Crit Care. 2014; 18: 212
        • Merchant R.M.
        • Becker L.B.
        • Abella B.S.
        • Asch D.A.
        • Groeneveld P.W.
        Cost-effectiveness of therapeutic hypothermia after cardiac arrest.
        Circ Cardiovasc Qual Outcomes. 2009; 2: 421-428
        • Kim Y.J.
        • Ahn S.
        • Sohn C.H.
        • et al.
        Long-term neurological outcomes in patients after out-of-hospital cardiac arrest.
        Resuscitation. 2016; 101: 1-5
        • Sterne J.A.
        • Hernan M.A.
        • Reeves B.C.
        • et al.
        ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.
        BMJ. 2016; 355: i4919
        • Lederer W.
        • Lichtenberger C.
        • Pechlaner C.
        • Kinzl J.
        • Kroesen G.
        • Baubin M.
        Long-term survival and neurological outcome of patients who received recombinant tissue plasminogen activator during out-of-hospital cardiac arrest.
        Resuscitation. 2004; 61: 123-129
        • Loma-Osorio P.
        • Aboal J.
        • Sanz M.
        • et al.
        Clinical characteristics and vital and functional prognosis of out-of-hospital cardiac arrest survivors admitted to five cardiac intensive care units.
        Rev Esp Cardiol (Engl Ed). 2013; 66: 623-628
        • Pleskot M.
        • Hazukova R.
        • Parizek P.
        • Cermakova E.
        • Tacheci I.
        A seven-year follow-up of discharged patients after out-of-hospital cardiac arrest with respect to ST-segment elevation.
        Signa Vitae. 2012; 7: 33-39
        • Storm C.
        • Wutzler A.
        • Trenkmann L.
        • et al.
        Good neurological outcome despite very low regional cerebral oxygen saturation during resuscitation – a prospective preclinical trial in 29 patients.
        Scand J Trauma Resusc Emerg Med. 2016; 24: 43
        • Matthews E.A.
        • Magid-Bernstein J.
        • Sobczak E.
        • et al.
        Prognostic value of the neurological examination in cardiac arrest patients after therapeutic hypothermia.
        Neurohospitalist. 2018; 8: 66-73
        • Kleissner M.
        • Sramko M.
        • Kohoutek J.
        • Kautzner J.
        • Kettner J.
        Impact of urgent coronary angiography on mid-term clinical outcome of comatose out-of-hospital cardiac arrest survivors presenting without ST-segment elevation.
        Resuscitation. 2015; 94: 61-66
        • Rubertsson S.
        • Lindgren E.
        • Smekal D.
        • et al.
        Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: The LINC Randomized Trial.
        JAMA. 2014; 311: 53-61
        • Sandroni C.
        • D’Arrigo S.
        • Nolan J.P.
        Prognostication after cardiac arrest.
        Critical Care. 2018; 22: 150
        • Paul M.
        • Bougouin W.
        • Geri G.
        • et al.
        Delayed awakening after cardiac arrest: prevalence and risk factors in the Parisian registry.
        Intensive Care Med. 2016; 42: 1128-1136
        • Pusswald G.
        • Fertl E.
        • Faltl M.
        • Auff E.
        Neurological rehabilitation of severely disabled cardiac arrest survivors. Part II. Life situation of patients and families after treatment.
        Resuscitation. 2000; 47: 241-248
        • Haywood K.
        • Whitehead L.
        • Nadkarni V.M.
        • et al.
        COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation.
        Circulation. 2018; 187: e783-e801
        • 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
        • Moulaert V.R.
        • Verbunt J.A.
        • van Heugten C.M.
        • et al.
        Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review.
        Resuscitation. 2009; 80: 297-305
        • Booth C.M.
        • Boone R.H.
        • Tomlinson G.
        • Detsky A.S.
        Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest.
        JAMA. 2004; 291: 870-879
        • Boyce L.W.
        • Goossens P.H.
        Rehabilitation after cardiac arrest: integration of neurologic and cardiac rehabilitation.
        Semin Neurol. 2017; 37: 94-102
        • Kleinman M.E.
        • Perkins G.D.
        • Bhanji F.
        • et al.
        ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement.
        Circulation. 2018; 137: e802-e819
        • Nielsen N.
        • Wetterslev J.
        • Cronberg T.
        • et al.
        Targeted temperature management at 33 °C versus 36 °C after cardiac arrest.
        N Engl J Med. 2013; 369: 2197-2206
        • Per N.
        • Taccone F.S.
        • Truhlar A.
        • et al.
        Effect of trans-nasal evaporative intra-arrest cooling on functional neurologic outcome in out-of-hospital cardiac arrest.
        JAMA. 2019; 321: 1677-1685