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Severity ‘score’ for cardiac arrest

U. PITTSBURGH (US) — Classifying patients after they have suffered cardiac arrest may lead to a more effective way to predict outcomes.

“Traditionally, we have used historical or event-related information, such as initial cardiac rhythm or whether someone witnessed the collapse, to categorize these patients upon arrival at the hospital,” says Jon C. Rittenberger, assistant professor of emergency medicine at the University of Pittsburgh.

“Unfortunately, more than 10 percent of the time, such information is unavailable, which limits our ability to tailor therapies, counsel families about prognosis, or select patients for clinical trials.”

The research is published in the journal Resuscitation.

Cardiac arrest is the most common cause of death in North America, resulting in approximately 350,000 deaths each year.

For the study, researchers looked at retrospective data for more than 450 post-cardiac arrest patients treated at UPMC Presbyterian between January 2005 and December 2009. Both in-hospital and out-of-hospital cardiac arrests were included.

In 2007, the hospital implemented a multi-disciplinary post-cardiac arrest care plan, including therapeutic hypothermia, or cooling of patients to minimize brain damage.

Four distinct categories of illness severity were identified based on a combination of neurological and cardiopulmonary dysfunction during the first few hours after restoration of a patient’s spontaneous circulation.

A broad fluctuation was seen when considering rates of survival, neurologic outcomes, and development of multiple organ failure for patients in each category.

“Now, objective data available to the clinician at the bedside during initial evaluation may provide a better way of predicting outcomes and guiding the decisions of families and clinicians,” says Rittenberger.

“We found that the category of illness severity had a stronger association with survival and good outcomes than did such historically used factors as initial rhythm of arrest or where it happened.

“Our results indicate that illness severity should be carefully measured and accounted for in future studies of therapies for these patients.”

The research was supported in part by the National Center for Research Resources.

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