Clinical paper| Volume 164, P30-37, July 2021

Association between functional status at hospital discharge and long-term survival after out-of-hospital-cardiac-arrest



      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.


      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.


      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).


      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.


      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


        • Benjamin Emelia J.
        • Paul Muntner
        • Alvaro Alonso
        • et al.
        Heart disease and stroke statistics—2019 update: a report from the American Heart Association.
        Circulation. 2019; 139: e56-e528
        • Geocadin Romergryko G.
        • Callaway Clifton W.
        • Fink Ericka L.
        • et al.
        Standards for studies of neurological prognostication in comatose survivors of cardiac arrest: a scientific statement from the American Heart Association.
        Circulation. 2019; 140: e517-e542
        • Idris A.H.
        • Bierens J.J.L.M.
        • Perkins G.D.
        • et al.
        2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: an ILCOR advisory statement.
        Resuscitation. 2017; 118: 147-158
        • Ajam K.
        • Gold L.S.
        • Beck S.S.
        • et al.
        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
        • Quinn T.J.
        • Dawson J.
        • Walters M.R.
        • Lees K.R.
        Exploring the reliability of the modified Rankin scale.
        Stroke. 2009; 40: 762-766
        • Rittenberger J.C.
        • Raina K.
        • Holm M.B.
        • et al.
        Association between Cerebral Performance Category, Modified Rankin Scale, and discharge disposition after cardiac arrest.
        Resuscitation. 2011; 82: 1036-1040
        • Kim H.-Y.
        Statistical notes for clinical researchers: chi-squared test and Fisher’s exact test.
        Restor Dent Endod. 2017; 42: 152-155
        • Zhang B.
        • Zhang Y.
        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): 1565
        • Goel M.K.
        • Khanna P.
        • Kishore J.
        Understanding survival analysis: Kaplan–Meier estimate.
        Int J Ayurveda Res. 2010; 1: 274-278
        • Grossestreuer A.V.
        • Abella B.S.
        • Sheak K.R.
        • et al.
        Inter-rater reliability of post- arrest cerebral performance category (CPC) scores.
        Resuscitation. 2016; 109: 21-24
        • Dumas F.
        • White L.
        • Stubbs B.A.
        • et al.
        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: 21-27
        • Dumas F.
        • Rea T.D.
        Long-term prognosis following resuscitation from out-of-hospital cardiac arrest: role of aetiology and presenting arrest rhythm.
        Resuscitation. 2012; 83: 1001-1005
        • Rea Thomas D.
        • Matthew Crouthamel
        • Eisenberg Mickey S.
        • et al.
        Temporal patterns in long-term survival after resuscitation from out-of-hospital cardiac arrest.
        Circulation. 2003; 108: 1196-1201
        • Banks J.L.
        • Marotta C.A.
        Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis.
        Stroke. 2007; 38: 1091-1096
        • Quinn T.J.
        • Dawson J.
        • Walters M.R.
        • Lees K.R.
        Reliability of the modified Rankin Scale.
        Stroke. 2007; 38 (author reply e145): e144
        • Rangaraju S.
        • Haussen D.
        • Nogueira R.G.
        • et al.
        Comparison of 3-month stroke disability and quality of life across modified Rankin scale categories.
        Interv Neurol. 2017; 6: 36-41
        • Pachys G.
        • Kaufman N.
        • Bdolah-Abram T.
        • et al.
        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: 1052-1058
        • Foreman K.J.
        • Marquez N.
        • Dolgert A.
        • et al.
        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: 2052-2090
      1. Flipbook. (Accessed 10 April 2021,