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Influence of comorbidities and clinical prediction model on neurological prognostication post out-of-hospital cardiac arrest
  1. Weiting Huang1,
  2. Gary Kuan Wee Teo1,
  3. Jack Wei-Chieh Tan1,
  4. Nur Shahidah Ahmad2,
  5. Hwee Hong Koh1,
  6. Marcus Eng Hock Ong2
  1. 1 Cardiology, National Heart Centre Singapore, Singapore, Singapore
  2. 2 Emergency Medicine, Singapore General Hospital, Singapore, Singapore
  1. Correspondence to Dr Weiting Huang; huang.weiting{at}singhealth.com.sg

Abstract

Background Survival with good neurological function post out-of-hospital cardiac arrest (OHCA), defined as cerebral performance category (CPC) 1–2, ranges from 1.6% to 3% in Asia. We aim to study the influence of comorbidities and peri-OHCA event factors on neurological recovery and develop a model that can help clinicians predict neurological function among patients with post-OHCA admitted to the hospital.

Methods This was a retrospective cohort study. All patients admitted post-OHCA from 1 January 2011 to 31 December 2015 to a tertiary centre were identified through the hospital OHCA registry. Patients who survived till hospital admission were included. Logistic regression was used to identify patient and peri-arrest factors that were significantly associated with survival with CPC 1–2. The significant factors for survival with CPC 1–2 were then put into a multivariable model and the discriminative ability was tested using the receiver operator characteristic (ROC) curve. Calibration and internal validation of the model were also performed. External validation in a small prospective cohort was also performed.

Results In our derivation cohort of 129 patients, 30.23% survived with CPC 1–2. Significant factors associated with survival with good neurological outcomes were age-adjusted Charlson Comorbidity Index ≤5, time to first return of spontaneous circulation ≤40 min, the presence of immediate bystander cardiopulmonary resuscitation and shockable rhythms. We also developed a nomogram which showed good internal (ROC curve 0.84; 95% CI 0.77 to 0.91) and external validation (ROC curve 0.90; 95% CI 0.81 to 1.00).

  • sudden cardiac death
  • ventricular fibrillation
  • emergency medicine
  • risk stratification

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Footnotes

  • Contributors All authors have participated in the work and have reviewed and agree with the content of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer None of the article contents are under consideration for publication in any other journal or have been published in any journal. No portion of the text has been copied from other material in the literature (unless in quotation marks, with citation). The authors are aware that it is their responsibility to obtain permission for any figures or tables reproduced from any prior publications and to cover fully any costs involved. Such permission must be obtained prior to final acceptance.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Singhealth Centralised Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Statistical code and raw data set can be made available upon request via contacting the corresponding author.

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