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. 2025 Jul 28;33(1):132.
doi: 10.1186/s13049-025-01445-9.

Use of the HOPE score to assess survival outcome of hypothermic cardiac arrest selected by ECLS rewarming

Nicolas Hall  1 , Jessika Métrailler-Mermoud  2 , Valentin Rousson  3 , Chloé Conforti  4 , Amélie Dupasquier  4 , Pierre-Nicolas Carron  1 , Silke Grabherr  5 , Bettina Schrag  6 , Matthias Kirsch  7 , Cheyenne Falat  8 , Dominique Delay  9 , Vincent Frochaux  2 , Mathieu Pasquier  10
Affiliations

Use of the HOPE score to assess survival outcome of hypothermic cardiac arrest selected by ECLS rewarming

Nicolas Hall et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: We studied adult hypothermic cardiac arrest (CA) patients admitted to a University Hospital (UH) and a Regional Hospital (RH) for whom Extracorporeal Life Support (ECLS) was implemented. We used the HOPE score to estimate individual survival probabilities and to compare overall results between hospitals.

Methods: We included hypothermic CA patients who underwent ECLS between 2000 and 2022. We assessed the predicted survival probabilities by calculating the HOPE scores, both at individual and hospital levels. We assessed the performance of a HOPE score cutoff of 10% in predicting survival to hospital discharge, as ECLS rewarming is currently recommended when the HOPE is ≥ 10%. We also assessed the utility of the HOPE score in evaluating and comparing patient management within and between two hospitals.

Results: In the 46 patients with successful ECLS implementation, a HOPE score < 10% would have contraindicated and therefore prevented futile ECLS rewarming procedures for 17 patients (37%) who did not survive, while finding that ECLS was indicated for 100% of survivors. The observed survival rate was 24% (UH: 35%, RH: 11%) whereas the HOPE score predicted a survival rate of 35% (UH: 41%, RH: 26%), suggesting underperformance of ECLS rewarming among both hospitals. The difference of survival between the two hospitals was not statistically significant.

Conclusions: This study confirmed the utility of the HOPE score in estimating individual survival probabilities. The HOPE score may also be used to estimate the overall survival rate in a patient cohort, enabling internal quality-control and outcome results comparisons between different settings.

Keywords: Accidental hypothermia; Benchmarking; Cardiac arrest; ECLS; Environmental hypothermia; HOPE score.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study and data collection were approved by the local ethics committee “Commission cantonale d’éthique de la recherche sur l’être humain – Vaud (CER-VD)”, Switzerland (N° 2022-01206). An anonymised data transfer agreement between the two participating hospitals was obtained. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study patients. Patients with hypothermic cardiac arrest at hospital admission (January 1, 2000, to June 29,2022). Abbreviations: CA, cardiac arrest; ECLS, extracorporeal life support; ED, emergency department; RH, Regional Hospital; ROSC, return of spontaneous circulation; UH, University Hospital
Fig. 2
Fig. 2
Eligibility for ECLSR by using the HOPE score and outcome comparison between medical centers (n=45). The HOPE score was not calculated for 1 patient at UH due to missing data and was further excluded for analysis. Abbreviations: UH, University Hospital; ECLSR, extracorporeal life support rewarming; HOPE, hypothermia outcome prediction after ECLS; RH, Regional Hospital
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