Department of Emergency and Critical Care Saiseikai Utsunomiya Hospital Utsunomiya Japan.
Department of Cardiology Saiseikai Utsunomiya Hospital Utsunomiya Japan.
J Am Heart Assoc. 2024 Jan 2;13(1):e031035. doi: 10.1161/JAHA.123.031035. Epub 2023 Dec 29.
Risk stratification is important in patients with post-cardiac arrest syndrome. The Post-Cardiac Arrest Syndrome for Therapeutic Hypothermia (CAST) and revised CAST (rCAST) scores have been well validated for predicting neurological outcomes, particularly for conventionally resuscitated patients with post-cardiac arrest syndrome. However, no studies have evaluated patients undergoing extracorporeal cardiopulmonary resuscitation.
Adult patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation were analyzed in this retrospective observational multicenter cohort study. We validated the accuracy of the CAST/rCAST scores for predicting neurological outcomes at 30 days. Moreover, we compared the predictive performance of these scores with the TiPS65 risk score derived from patients with out-of-hospital cardiac arrest who were resuscitated using extracorporeal cardiopulmonary resuscitation. A total of 1135 patients were analyzed. The proportion of patients with favorable neurological outcomes was 16.6%. In the external validation, the area under the receiver operating characteristic curve of the CAST score was significantly higher than that of the rCAST score (area under the receiver operating characteristic curve 0.677 versus 0.603; <0.001), but there was no significant difference with that of the TiPS65 score (versus 0.633; =0.154). Both CAST/rCAST risk scores showed good calibration (Hosmer-Lemeshow test: =0.726 and 0.674), and the CAST score showed significantly better predictability in net reclassification compared with the rCAST (<0.001) and TiPS65 scores (=0.001).
The prognostic accuracy of the CAST score was significantly better than that of other risk scores in net reclassification. The CAST score may help to predict neurological outcomes in patients with out-of-hospital cardiac arrest who undergo extracorporeal cardiopulmonary resuscitation. However, the predictive value of the CAST score was not sufficiently high for clinical application.
URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577; Unique identifier: UMIN000036490.
在心脏骤停后综合征患者中，风险分层很重要。CAST（心脏骤停后综合征用于低温治疗）和修订后的 CAST（rCAST）评分已被很好地验证可用于预测神经结局，尤其是对于接受常规心脏骤停后综合征复苏的患者。然而，尚无研究评估行体外心肺复苏的患者。
本回顾性观察性多中心队列研究分析了行体外心肺复苏的院外心脏骤停成年患者。我们验证了 CAST/rCAST 评分对预测 30 天神经结局的准确性。此外，我们比较了这些评分与源自接受体外心肺复苏复苏的院外心脏骤停患者的 TiPS65 风险评分的预测性能。共分析了 1135 例患者。神经结局良好的患者比例为 16.6%。在外部验证中，CAST 评分的受试者工作特征曲线下面积明显高于 rCAST 评分（受试者工作特征曲线下面积 0.677 比 0.603；<0.001），但与 TiPS65 评分无显著差异（0.633；=0.154）。CAST/rCAST 风险评分均显示良好的校准度（Hosmer-Lemeshow 检验：=0.726 和 0.674），CAST 评分在净重新分类方面的预测能力明显优于 rCAST（<0.001）和 TiPS65 评分（=0.001）。
在净重新分类方面，CAST 评分的预后准确性明显优于其他风险评分。CAST 评分可能有助于预测行体外心肺复苏的院外心脏骤停患者的神经结局。然而，CAST 评分的预测价值尚不足以为临床应用提供依据。
网址：https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577；唯一标识符：UMIN000036490。
