Early Prognostication After Out-of-Hospital Cardiac Arrest: Modified rCAST Score Incorporating Age and Brainstem...

Area of Science:

• Neurology
• Cardiology
• Critical Care Medicine

Background:

• Out-of-hospital cardiac arrest (OHCA) survivors experience variable neurological outcomes due to hypoxic-ischemic brain injury.
• Early prognostic assessment in the emergency department is crucial for guiding clinical decisions.
• The revised Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) score aids in prognostic stratification.

Purpose of the Study:

• To enhance the predictive accuracy of the rCAST score for neurological outcomes in OHCA survivors.
• To develop a modified rCAST (mCAST) score by incorporating additional clinical variables.
• To evaluate the mCAST score's ability to predict poor neurological outcomes.

Main Methods:

• A multicenter observational study involving 881 OHCA survivors treated with targeted temperature management (TTM).
• Data collected from October 2015 to December 2018 across 22 university-affiliated hospitals in the Korean Hypothermia Network registry.
• Multivariable logistic regression identified independent predictors (age > 65, absence of brainstem reflexes) for poor neurological status (Cerebral Performance Category score 3-5 at one month).

Main Results:

• The mCAST score demonstrated superior prognostic accuracy compared to the original rCAST (AUC 0.849 vs. 0.823, p < 0.001).
• In the high-severity group, mCAST identified a higher poor outcome rate (95.1% vs. 90.9%) and reduced the proportion of patients classified in this group (20.7% vs. 31.3%).
• Age > 65 years and absence of brainstem reflexes were significant independent predictors of poor neurological outcomes.

Conclusions:

• The mCAST score significantly improves early prognostic accuracy for neurological outcomes in OHCA survivors.
• Incorporating age and brainstem reflexes into the rCAST score enhances its predictive capability.
• The mCAST score offers refined risk stratification in the immediate post-cardiac arrest period without compromising clinical feasibility.