Open AccessC‐ GRA pH : A Validated Scoring System for Early Stratification of Neurologic Outcome After Out‐of‐Hospital Cardiac Arrest Treated With Targeted Temperature Management
Author(s) -
Kiehl Erich L.,
Parker Alex M.,
Matar Ralph M.,
Gottbrecht Matthew F.,
Johansen Michelle C.,
Adams Mark P.,
Griffiths Lori A.,
Dunn Steven P.,
Bidwell Katherine L.,
Me Venu,
Enfield Kyle B.,
Gimple Lawrence W.
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.116.003821
Subject(s) - medicine , targeted temperature management , risk stratification , intensive care medicine , emergency medicine , cardiology , resuscitation , cardiopulmonary resuscitation , return of spontaneous circulation
Background Out‐of‐hospital cardiac arrest ( OHCA ) results in significant morbidity and mortality, primarily from neurologic injury. Predicting neurologic outcome early post‐ OHCA remains difficult in patients receiving targeted temperature management. Methods and Results Retrospective analysis was performed on consecutive OHCA patients receiving targeted temperature management (32–34°C) for 24 hours at a tertiary‐care center from 2008 to 2012 (development cohort, n=122). The primary outcome was favorable neurologic outcome at hospital discharge, defined as cerebral performance category 1 to 2 (poor 3–5). Patient demographics, pre‐ OHCA diagnoses, and initial laboratory studies post‐resuscitation were compared between favorable and poor neurologic outcomes with multivariable logistic regression used to develop a simple scoring system ( C‐ GRA pH ). The C‐ GRA pH score ranges 0 to 5 using equally weighted variables: ( C ): coronary artery disease, known pre‐ OHCA ; ( G ): glucose ≥200 mg/dL; ( R ): rhythm of arrest not ventricular tachycardia/fibrillation; ( A ): age >45; ( pH ): arterial pH ≤7.0. A validation cohort (n=344) included subsequent patients from the initial site (n=72) and an external quaternary‐care health system (n=272) from 2012 to 2014. The c‐statistic for predicting neurologic outcome was 0.82 (0.74–0.90, P <0.001) in the development cohort and 0.81 (0.76–0.87, P <0.001) in the validation cohort. When subdivided by C‐ GRA pH score, similar rates of favorable neurologic outcome were seen in both cohorts, 70% each for low (0–1, n=60), 22% versus 19% for medium (2–3, n=307), and 0% versus 2% for high (4–5, n=99) C‐ GRA pH scores in the development and validation cohorts, respectively. Conclusions C‐ GRA pH stratifies neurologic outcomes following OHCA in patients receiving targeted temperature management (32–34°C) using objective data available at hospital presentation, identifying patient subsets with disproportionally favorable ( C‐ GRA pH ≤1) and poor ( C‐ GRA pH ≥4) prognoses.