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. 2022 Dec 28;12(1):242.
doi: 10.3390/jcm12010242.

Does One Size Fit All? External Validation of the rCAST Score to Predict the Hospital Outcomes of Post-Cardiac Arrest Patients Receiving Targeted Temperature Management

Chao-Hsien Chen  1   2 , Chieh-Jen Wang  1 , I-Ting Wang  1   2 , Sheng-Hsiung Yang  1   2 , Ya-Hui Wang  3 , Chang-Yi Lin  1   2
Affiliations

Does One Size Fit All? External Validation of the rCAST Score to Predict the Hospital Outcomes of Post-Cardiac Arrest Patients Receiving Targeted Temperature Management

Chao-Hsien Chen et al. J Clin Med. .

Abstract

The revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) score was proposed to predict neurologic outcomes and mortality among out-of-hospital cardiac arrest (OHCA) patients. However, it has rarely been validated outside Japan. Therefore, this study aimed to investigate this issue. All adult patients admitted to our medical intensive care unit for targeted temperature management (TTM) between July 2015 and July 2021 were enrolled. Their medical records were retrieved, and rCAST scores were calculated. A total of 108 post-cardiac arrest syndrome (PCAS) patients who received TTM were analyzed. According to the rCAST score, 49.1%, 50.0%, and 0.9% of the patients were classified as low, moderate, and high severity, respectively. The areas under the curves for the rCAST score were 0.806 (95% confidence interval [CI]: 0.719-0.876) and 0.794 (95% CI: 0.706-0.866) to predict poor neurologic outcomes and mortality at day 28, respectively. In contrast to the original report, only low-severity patients had favorable neurologic outcomes. The rCAST score showed moderate accuracy in our OHCA patients with PCAS who received TTM to predict poor neurologic outcomes and mortality at day 28.

Keywords: mortality; neurologic outcome; out-of-hospital cardiac arrest; post-cardiac arrest syndrome; rCAST; targeted temperature management.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient enrollment flow diagram. ICU: intensive care unit, IHCA: in-hospital cardiac arrest, PCAS: post-cardiac arrest syndrome, TTM: targeted temperature management.
Figure 2
Figure 2
The distribution of the rCAST score and the three severity categories.
Figure 3
Figure 3
Receiver operating characteristic curves of rCAST score for predicting poor neurologic outcome (A) or mortality (B) at day 28. Light blue areas represent the 95% confidence interval. AUC: area under the curve.
Figure 4
Figure 4
Sensitivity and specificity of using the rCAST score to predict poor neurological outcomes at day 28 in out-of-hospital cardiac arrest patients. There was decreased sensitivity and increased specificity to using a higher rCAST score as a cut point to predict the poor neurologic outcomes.
See this image and copyright information in PMC

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