Abstract
Background
Out-of-hospital cardiac arrest (OHCA) causes brain injury. Functional status of survivors
at hospital discharge is a core resuscitation measure, frequently using the Cerebral
Performance Category (CPC) or modified Rankin Scale (mRS). Which scale better predicts
long-term survival following OHCA is not known.
Methods
We evaluated long-term survival after hospital discharge in a retrospective cohort
of persons resuscitated from OHCA in King County, WA from 2007 to 2015. Patients were
independently assessed at discharge using both scales, leveraging the regional quality
improvement registry, which records the 5-level CPC, and concurrent research studies
involving the Resuscitation Outcomes Consortium, which used the 7-level mRS, taken
from information in the hospital record. The risk of mortality associated with CPC
and mRS categories was estimated using Kaplan–Meier survival analysis and Cox proportional
hazards regression.
Results
Among 878 eligible patients discharged alive, there were 358 deaths during 9118.5
person-years of follow-up. Overall 1, 5 and 10-year survival was 84.4%, 68.5%, and
53.7% and varied according to CPC and mRS (p < 0.01 per Kaplan–Meier). Compared to
CPC-1, hazard ratio (HR) increased incrementally for CPC-2 = 1.33 (1.03–1.73), CPC-3
= 1.90 (1.37–2.65), and CPC-4 = 8.25 (5.63–12.10). Compared to mRS = 0, HR for mRS-1
= 1.02 (0.66–1.58), mRS-2 = 1.52 (1.00–2.32), mRS-3 = 1.41 (0.92–2.14), mRS-4 = 2.00
(1.37–2.97), and mRS-5 = 4.90 (3.23–7.44).
Conclusion
In OHCA survivors, CPC and mRS scales both predicted long-term survival. However mRS
0−1 and 2−3 groups did not have distinct prognoses, suggesting that a consolidated
mRS score may simplify capture of relevant prognostic information for survival predictions.
Keywords
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References
- Heart disease and stroke statistics—2019 update: a report from the American Heart Association.Circulation. 2019; 139: e56-e528https://doi.org/10.1161/CIR.0000000000000659
- Standards for studies of neurological prognostication in comatose survivors of cardiac arrest: a scientific statement from the American Heart Association.Circulation. 2019; 140: e517-e542https://doi.org/10.1161/CIR.0000000000000702
- 2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: an ILCOR advisory statement.Resuscitation. 2017; 118: 147-158https://doi.org/10.1016/j.resuscitation.2017.05.028
- 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: 38https://doi.org/10.1186/1757-7241-19-38
- Exploring the reliability of the modified Rankin scale.Stroke. 2009; 40: 762-766https://doi.org/10.1161/STROKEAHA.108.522516
- Association between Cerebral Performance Category, Modified Rankin Scale, and discharge disposition after cardiac arrest.Resuscitation. 2011; 82: 1036-1040https://doi.org/10.1016/j.resuscitation.2011.03.034
- Statistical notes for clinical researchers: chi-squared test and Fisher’s exact test.Restor Dent Endod. 2017; 42: 152-155https://doi.org/10.5395/rde.2017.42.2.152
- Mann–Whitney U test and Kruskal–Wallis test should be used for comparisons of differences in medians, not means: comment on the article by van der Helm-van Mil et al.Arthritis Rheum. 2009; 60 (author reply 1565): 1565https://doi.org/10.1002/art.24497
- Understanding survival analysis: Kaplan–Meier estimate.Int J Ayurveda Res. 2010; 1: 274-278https://doi.org/10.4103/0974-7788.76794
- Inter-rater reliability of post- arrest cerebral performance category (CPC) scores.Resuscitation. 2016; 109: 21-24https://doi.org/10.1016/j.resuscitation.2016.09.006
- Long-term prognosis following resuscitation from out of hospital cardiac arrest: role of percutaneous coronary intervention and therapeutic hypothermia.J Am Coll Cardiol. 2012; 60: 21-27https://doi.org/10.1016/j.jacc.2012.03.036
- Long-term prognosis following resuscitation from out-of-hospital cardiac arrest: role of aetiology and presenting arrest rhythm.Resuscitation. 2012; 83: 1001-1005https://doi.org/10.1016/j.resuscitation.2012.01.029
- Temporal patterns in long-term survival after resuscitation from out-of-hospital cardiac arrest.Circulation. 2003; 108: 1196-1201https://doi.org/10.1161/01.CIR.0000087403.24467.A4
- Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis.Stroke. 2007; 38: 1091-1096https://doi.org/10.1161/01.STR.0000258355.23810.c6
- Reliability of the modified Rankin Scale.Stroke. 2007; 38 (author reply e145): e144https://doi.org/10.1161/STROKEAHA.107.490110
- Comparison of 3-month stroke disability and quality of life across modified Rankin scale categories.Interv Neurol. 2017; 6: 36-41https://doi.org/10.1159/000452634
- Predictors of long-term survival after out-of-hospital cardiac arrest: the impact of Activities of Daily Living and Cerebral Performance Category scores.Resuscitation. 2014; 85: 1052-1058https://doi.org/10.1016/j.resuscitation.2014.03.312
- Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories.Lancet Lond Engl. 2018; 392: 2052-2090https://doi.org/10.1016/S0140-6736(18)31694-5
Flipbook. (Accessed 10 April 2021, https://mycares.net/sitepages/uploads/2020/2019_flipbook/index.html?page=32).
Article info
Publication history
Published online: May 06, 2021
Accepted:
April 26,
2021
Received in revised form:
April 10,
2021
Received:
February 4,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
