Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Am J Emerg Med. 2024 Jan;75:46-52. doi: 10.1016/j.ajem.2023.10.028. Epub 2023 Oct 20.
The neurologic prognosis of out-of-hospital cardiac arrest (OHCA) patients in whom return of spontaneous circulation (ROSC) is achieved remains poor. The aim of this study was to externally and prospectively validate two scoring systems developed by us: the CAST score, a scoring system to predict the neurological prognosis of OHCA patients undergoing targeted temperature management (TTM), and a simplified version of the same score developed for improved ease of use in clinical settings, the revised CAST (rCAST) score.
This study was a prospective, multicenter, observational study conducted using the SOS KANTO 2017 registry, an OHCA registry involving hospitals in the Kanto region (including Tokyo) of Japan. The primary outcome was favorable neurological outcome (defined as Cerebral Performance Category score of 1 or 2) at 30 days and the secondary outcomes were favorable neurological outcome at 90 days and survival at 30 and 90 days. The predictive accuracies of the original CAST (oCAST) and rCAST scores were evaluated by using area under the receiver operating characteristic curve (AUC).
Of 9909 OHCA patients, 565 showed ROSC and received TTM. Of these, we analyzed the data of 259 patients in this study. The areas under the receiver operating characteristic curve (AUCs) of the oCAST and rCAST scores for predicting a favorable neurological outcome at 30 days were 0.86 and 0.87, respectively, and those for predicting a favorable neurological outcome at 90 days were 0.87 and 0.88, respectively. The rCAST showed a higher predictive accuracy for the neurological outcome as compared with the NULL-PLEASE score. The patients with a favorable neurological outcome who had been classified into the high severity group based on the rCAST tended to have hypothermia at hospital arrival and to not show any signs of loss of gray-white matter differentiation on brain CT. Neurological function at 90 days was correlated with the rCAST (r = 0.63, p < 0.001).
rCAST showed high predictive accuracy for the neurological prognosis of OHCA patients managed by TTM, comparable to that of the oCAST score. The scores on the rCAST were strongly correlated with the neurological functions at 90 days, implying that the rCAST is a useful scale for assessing the severity of brain injury after cardiac arrest.
自主循环恢复（ROSC）的院外心脏骤停（OHCA）患者的神经预后仍然较差。本研究的目的是外部前瞻性验证我们开发的两个评分系统：CAST 评分，一种预测接受目标温度管理（TTM）的 OHCA 患者神经预后的评分系统，以及为提高临床使用便利性而开发的该评分的简化版，即改良 CAST（rCAST）评分。
这是一项使用 SOS KANTO 2017 登记处进行的前瞻性、多中心、观察性研究，该登记处涉及日本关东地区（包括东京）的医院。主要结局为 30 天时的良好神经功能结局（定义为脑功能分类评分 1 或 2），次要结局为 90 天时的良好神经功能结局和 30 天和 90 天时的生存。使用受试者工作特征曲线下面积（AUC）评估原始 CAST（oCAST）和 rCAST 评分的预测准确性。
在 9909 例 OHCA 患者中，有 565 例出现 ROSC 并接受了 TTM。在这些患者中，我们分析了本研究中 259 例患者的数据。oCAST 和 rCAST 评分预测 30 天良好神经功能结局的 AUC 分别为 0.86 和 0.87，预测 90 天良好神经功能结局的 AUC 分别为 0.87 和 0.88。rCAST 对神经预后的预测准确性高于 NULL-PLEASE 评分。根据 rCAST 分类为严重程度高的患者，其在到达医院时体温较低，且脑 CT 上未见灰白质分化丧失的迹象。90 天时的神经功能与 rCAST 相关（r=0.63，p<0.001）。
rCAST 对 TTM 治疗的 OHCA 患者的神经预后具有较高的预测准确性，与 oCAST 评分相当。rCAST 评分与 90 天时的神经功能高度相关，这意味着 rCAST 是评估心脏骤停后脑损伤严重程度的有用量表。
