Using risk prediction tools in survivors of in-hospital cardiac arrest

Abstract

In-hospital cardiac arrests are common and associated with poor outcomes. Predicting the likelihood of favorable neurological survival following resuscitation from an in-hospital cardiac arrest could provide important information for physicians and families. In this article, we review the literature regarding predictors of survival following in-hospital cardiac arrest. Specifically, we describe the Cardiac Arrest Survival Postresuscitation In-hospital (CASPRI) score that was recently developed and validated using data from the Get With the Guidelines-Resuscitation registry. The CASPRI score includes 11 predictor variables: age, initial cardiac arrest rhythm, defibrillation time, baseline neurological status, duration of resuscitation, mechanical ventilation, renal insufficiency, hepatic insufficiency, sepsis, malignancy, and hypotension. The score is simple to use at the bedside, has excellent discrimination and calibration, and provides robust estimates of the probability of favorable neurological survival after an in-hospital cardiac arrest. Thus, CASPRI may be valuable in establishing expectations by physicians and families in the critical period after these high-risk events.

Fig. 1

The Cardiac Arrest Survival Postresuscitation In-hospital (CASPRI) scorecard and nomogram for favorable neurological survival. For this in-hospital cardiac arrest risk score, points for each variable are determined, and a summary score is obtained. The corresponding likelihood of surviving to hospital discharge without severe neurological disability is determined from the risk table or plot. CPC indicates cerebral performance category, VF/VT ventricular fibrillation or ventricular tachycardia. (Reproduced with permission from: Chan PS, Spertus JA, Krumholz HM, Berg RA, Li Y, Sasson C, Nallamothu BK. A validated prediction tool for initial survivors of in-hospital cardiac arrest. Arch Intern Med. 2012;172:947–953) [••]

Fig. 2

Comparison of predicted vs. observed outcome rate for the validation cohort. Each data point represents a decile of risk for the outcome of favorable neurological survival to discharge. CASPRI indicates Cardiac Arrest Survival Postresuscitation In-hospital. (Reproduced with permission from: Chan PS, Spertus JA, Krumholz HM, Berg RA, Li Y, Sasson C, Nallamothu BK. A validated prediction tool for initial survivors of in-hospital cardiac arrest. Arch Intern Med. 2012;172:947–953) [••]