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Dynamic SCAI Shock Grade Is Independently Associated With Circulatory Death After Resuscitation of Out-of-Hospital
George Kaye1, Prajith Jeyaprakash1, Muhamad Abdrazak1,2
1King's College Hospital NHS Foundation Trust, London, UK.
Insights
Deterioration in Society for Cardiovascular Angiography and Interventions (SCAI) Shock Grade after out-of-hospital cardiac arrest (OHCA) is linked to increased circulatory death. Monitoring SCAI Grade changes in intensive care units (ICUs) can help predict patient outcomes.
Area of Science:
- Cardiology
- Critical Care Medicine
- Emergency Medicine
Background:
- Cardiogenic shock (CS) is a frequent complication in patients experiencing out-of-hospital cardiac arrest (OHCA).
- Effective risk stratification is crucial for managing these high-risk patients.
Purpose of the Study:
- To determine if changes in SCAI Shock Grade between hospital and intensive care unit (ICU) admission correlate with patient outcomes following OHCA.
- To identify predictors of SCAI grade changes and circulatory mortality in OHCA survivors.
Main Methods:
- Analysis of the King's Out-of-Hospital Cardiac Arrest Registry (2012-2021) for patients with OHCA of cardiac etiology.
- SCAI Shock Grade assessed at hospital and ICU admission, categorizing patients into improving, static, or worsening groups.
- Primary endpoint: 30-day in-hospital mortality; secondary analysis of circulatory and neurological death using regression models.
Main Results:
- Of 493 patients, 32% showed improved SCAI Grade, 43% remained static, and 25% deteriorated between admissions.
- Overall mortality did not significantly differ based on SCAI Grade change (p=0.2).
- Circulatory death was significantly higher in patients with deteriorating SCAI Grade (28%) compared to static (19%) and improving (13%) groups (p=0.010).
Conclusions:
- Deterioration of SCAI Shock Grade from hospital to ICU admission is an independent predictor of circulatory death in OHCA patients.
- SCAI Grade changes provide valuable prognostic information for risk stratification and management of cardiogenic shock post-OHCA.
Background:
Cardiogenic shock (CS) is a common complication of patients with resuscitated out-of-hospital cardiac arrest (OHCA).
Aims:
This study investigates whether the change in SCAI Shock Grade, measured between hospital and intensive care admission (ICU), is associated with outcome after OHCA.
Methods:
Patients with OHCA of suspected cardiac etiology were included from the King's Out-of-Hospital Cardiac Arrest Registry between 2012 and 2021. SCAI Shock Grade was determined on hospital and ICU admission. Patients were categorized into worsening, static, or improving SCAI Grade. The primary endpoint was in-hospital mortality at 30 days. Predictors of SCAI change and circulatory mortality were assessed using univariable and multivariable regression.
Results:
Of 493 patients (median age 63 years, 77% male), 68% had a shockable rhythm, 80% were witnessed, and 94% had bystander CPR. SCAI Grade between hospital and ICU admission improved in 32% of patients, was static in 43% and deteriorated in 25%. Amongst the overall cohort, circulatory death occurred in 19% of patients and neurological death occurred in 28% of patients. Mortality did not differ between groups based on the change in SCAI grade (p = 0.2). However, circulatory death was more common in patients with deteriorating SCAI Grade (28%), compared to static (19%) and improving (13%) SCAI (p = 0.010). Multivariable regression modeling showed that SCAI change was independently associated with circulatory death, along with age, lactate, and MIRACLE2 score.
Conclusion:
In patients with OHCA complicated by CS, deterioration in SCAI Grade between cardiac center arrival and ICU admission is independently associated with circulatory death.
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