Predictive value of hospital discharge neurological outcome scores for long-term neurological status following out-of-hospital cardiac arrest: A systematic review

Abstract

Introduction: Neurological status following out-of-hospital cardiac arrest is commonly assessed using measures such as the Cerebral Performance Category (CPC) at hospital discharge. However, it remains unclear if these measures accurately reflect long-term neurological status after discharge. The objective of this systematic review was to determine the association between post-arrest neurological outcome scores at hospital discharge and long-term (>6 months) neurological outcome scores.

Methods: Comprehensive database searches of Medline, Embase, and the Cochrane library databases from inception to August 2019 were conducted and reference lists were hand-searched. Randomized controlled trials (RCT) and prospective observational studies were included.

Results: After screening 7844 titles and abstracts independently and in duplicate, we included 7 studies with a total of 602 patients from 6 prospective observational studies and 1 RCT. Four studies reported long-term follow-up at 6 months post-arrest and three studies reported follow-up at 1 year. In the studies with 6-month follow-up, 368 patients (82.7%) had favorable short-term neurological scores (CPC 1-2) at discharge or 30 days post-arrest, and 352 patients (79.1%) had favorable scores at 6 months post-arrest. In the studies with 1-year follow-up, 101 patients (64.3%) had favorable neurological scores at discharge or 30 days post-arrest, and 91 patients (59.5%) patients had favorable neurological scores at 1 year.

Conclusions: Long-term neurological outcome scores following OHCA were consistent with short-term outcome at hospital discharge or 30 days post-arrest. All included studies measured neurological outcome using CPC, further studies are needed using other standards to better elucidate patient-centered long-term neurological outcome.

Keywords: Cerebral performance category; Functional outcome; Long-term neurological status; Neurological status; Out of hospital cardiac arrest.