Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score.

TitleHypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score.
Publication TypeJournal Article
Year of Publication2018
AuthorsPasquier, M, Hugli, O, Paal, P, Darocha, T, Blancher, M, Husby, P, Silfvast, T, Carron, P-N, Rousson, V
JournalResuscitation
Volume126
Pagination58-64
Date Published05/2018
DOI10.1016/j.resuscitation.2018.02.026
ISSN1873-1570
KeywordsAccidental, Adolescent, Adult, Cardiac arrest, Cardiopulmonary Resuscitation/statistics & numerical data, Clinical Decision-Making, ECMO, ECPR, Extracorporeal Membrane Oxygenation/methods, Extracorporeal Membrane Oxygenation/mortality, Humans, Hypothermia, Hypothermia/blood, Hypothermia/complications, Hypothermia/mortality, Hypothermia/therapy, Male, Middle Aged, Out-of-Hospital Cardiac Arrest/etiology, Out-of-Hospital Cardiac Arrest/mortality, Out-of-Hospital Cardiac Arrest/therapy, Potassium, Potassium/blood, Predictive Value of Tests, Resuscitation, Retrospective Studies, Rewarming/methods, Treatment Outcome, Triage, Young Adult
Abstract

AIMS: Currently, the decision to initiate extracorporeal life support for patients who suffer cardiac arrest due to accidental hypothermia is essentially based on serum potassium level. Our goal was to build a prediction score in order to determine the probability of survival following rewarming of hypothermic arrested patients based on several covariates available at admission.

METHODS: We included consecutive hypothermic arrested patients who underwent rewarming with extracorporeal life support. The sample comprised 237 patients identified through the literature from 18 studies, and 49 additional patients obtained from hospital data collection. We considered nine potential predictors of survival: age; sex; core temperature; serum potassium level; mechanism of hypothermia; cardiac rhythm at admission; witnessed cardiac arrest, rewarming method and cardiopulmonary resuscitation duration prior to the initiation of extracorporeal life support. The primary outcome parameter was survival to hospital discharge.

RESULTS: Overall, 106 of the 286 included patients survived (37%; 95% CI: 32-43%), most (84%) with a good neurological outcome. The final score included the following variables: age, sex, core temperature at admission, serum potassium level, mechanism of cooling, and cardiopulmonary resuscitation duration. The corresponding area under the receiver operating characteristic curve was 0.895 (95% CI: 0.859-0.931) compared to 0.774 (95% CI: 0.720-0.828) when based on serum potassium level alone.

CONCLUSIONS: In this large retrospective study we found that our score was superior to dichotomous triage based on serum potassium level in assessing which hypothermic patients in cardiac arrest would benefit from extracorporeal life support. External validation of our findings is required.

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/29481910?dopt=Abstract

WOS ID (UT)

000430076700026

Alternate JournalResuscitation
Citation Key / SERVAL ID8873
Peer reviewRefereed
PubMed ID29481910

                         

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