Prognostic performance of simplified out-of-hospital cardiac arrest (OHCA) and cardiac arrest hospital prognosis (CAHP) scores in an East Asian population: A prospective cohort study.

Abstract

The out-of-hospital cardiac arrest (OHCA) and cardiac arrest hospital prognosis (CAHP) scores were developed for early neuroprognostication after OHCA. Calculation of both scores requires estimation of the no-flow interval, which may be imprecise. We aimed to validate simplified OHCA and CAHP scores, which exclude the no-flow interval, in an East Asian cohort. This was a single-centre prospective observational study. Consecutive OHCA patients were screened between January 2011 and March 2017. Simplified OHCA and CAHP scores (sOHCA, sCAHP) were calculated as the original scores with the no-flow interval omitted. Association between independent variables and outcomes was examined by multivariate logistic regression analysis, and area under the receiver operating characteristics curve (AUC) values were compared by paired DeLong test. A total of 412 patients were included. An inverse association between sOHCA and sCAHP scores and neurological outcome was confirmed, and most of the variables included in the simplified score calculations were also independently associated with neurological outcomes in our cohort. The AUC values for the simplified scores were similar, and both had excellent discriminatory performance for favourable neurologic outcome (AUC = 0.82, 95% confidence interval 0.77-0.86 for sOHCA and 0.84 with 95% confidence interval 0.80-0.89 for sCAHP, p-value = 0.19). The simplified OHCA and CAHP scores predicted neurological outcomes in successfully resuscitated East Asian OHCA patients with similar and excellent accuracy. The simplified OHCA and CAHP scores could potentially serve alongside the original scores as risk-adjustment tools for comparison of outcomes between regional OHCA registries worldwide.