Prearrest prediction of favourable neurological survival following in-hospital cardiac arrest: The Prediction of outcome for In-Hospital Cardiac Arrest (PIHCA) score. (October 2019)

• Record Type: Journal Article
• Authors: Piscator, Eva; Göransson, Katarina; Forsberg, Sune; Bottai, Matteo; Ebell, Mark; Herlitz, Johan; Djärv, Therese
• Is Part Of: Resuscitation. Volume 143(2019)
• Page Start: 92
• Page End: 99
• Publication Date: 2019-10
• Subjects: In-hospital cardiac arrest -- Heart arrest -- Cardiopulmonary resuscitation -- Prognosis -- Clinical decision-making -- Medical futility -- Models-Statistical; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2019.08.010
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Background: A prearrest prediction tool can aid clinicians in consolidating objective findings with clinical judgement and in balance with the values of the patient be a part of the decision process for do-not-attempt-resuscitation (DNAR) orders. A previous prearrest prediction tool for in-hospital cardiac arrest (IHCA) have not performed satisfactory in external validation in a Swedish cohort. Therefore our aim was to develop a prediction model for the Swedish setting. Methods: Model development was based on previous external validation of The Good Outcome Following Attempted Resuscitation (GO-FAR) score, with 717 adult IHCAs. It included redefinition and reduction of predictors, and addition of chronic comorbidity, to create a full model of 9 predictors. Outcome was favourable neurological survival defined as Cerebral Performance Category score 1–2 at discharge. The likelihood of favourable neurological survival was categorised into very low (<1%), low (1–3%) and above low (>3%). Results: We called the model the Prediction of outcome for In-Hospital Cardiac Arrest (PIHCA) score. The AUROC was 0.808 (95% CI 0.807–0.810) and calibration was satisfactory. With a cutoff of 3% likelihood of favourable neurological survival sensitivity was 99.4% and specificity 8.4%. Although specificity was limited, predictive value for classification into ≤3% likelihood of favorable neurological survival was high (97.4%) and false classification into ≤3% likelihood of favourable neurological survival was low (0.6%). Conclusion: The PIHCA score has the potential to be used as an objective tool in prearrest prediction of outcome after IHCA, as part of the decision process for a DNAR order.