Abstract
Early prognostication post-cardiac arrest can help determine appropriate medical management
and help evaluate effectiveness of post-arrest interventions. The Pittsburgh Cardiac
Arrest Category (PCAC) severity score is a 4-level illness severity score found to
strongly predict patient outcomes in both in- (IHCA) and out-of-hospital cardiac arrests
(OHCA). We aimed to validate the PCAC severity score in an external cohort of cardiac
arrest patients.
Methods
We retrospectively assigned PCAC scores to both IHCA and OHCA patients treated by
our hypothermia team from July 1, 2009 to July 1 2016. Our primary outcome was survival
to hospital discharge. Secondary outcomes were favorable functional status defined
as favorable discharge disposition (home or acute rehabilitation), discharge Cerebral
Performance Category (CPC); and discharge modified Rankin Scale (mRS). We tested the
association of PCAC and outcomes using a multivariable adjusted logistic regression
model.
Results
We included 317 subjects in our model. PCAC was strongly associated with survival
I Reference; II adjusted odds ratio (OR) 0.20 95% confidence interval (CI) 0.35–0.66,
III (OR 0.14 CI 0.3–0.73, p < 0.05); IV (OR 0.05 CI 0.01–0.24, p < 0.01). PCAC was similarly associated with favorable functional outcomes: favorable
discharge disposition II (OR 0.12 CI 0.02–0.68), III (OR 0.19 CI 0.05–0.74, p < 0.05) IV (OR 0.05 CI 0.01–0.22, p < 0.01); favorable CPC score II (OR 0.25 CI 0.06–1.03), III (OR 0.14 CI 0.03–0.57,
p < 0.01), IV (OR 0.05 CI 0.01–0.20, p < 0.01) and favorable mRS (OR 0.47 CI (0.33–0.68)).
Conclusion
Early (<6 h post-arrest) PCAC severity scoring strongly predicts patient outcomes
from cardiac arrest in both OHCA and IHCA.
Keywords
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Article info
Publication history
Published online: December 27, 2021
Accepted:
December 20,
2021
Received in revised form:
December 14,
2021
Received:
June 15,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
