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Swindell WR, Gibson CG. A simple ABCD score to stratify patients with respect to the probability of survival following in-hospital cardiopulmonary resuscitation. J Community Hosp Intern Med Perspect 2021; 11:334-342. [PMID: 34234902 PMCID: PMC8118500 DOI: 10.1080/20009666.2020.1866251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) is occurring more frequently at community hospitals but most patients undergoing CPR do not survive to discharge. Tools to predict CPR survival can be improved by the identification of high-yield clinical indicators. OBJECTIVE To identify variables associated with survival to discharge following in-hospital cardiac arrest. METHODS Retrospective cohort study of 463,530 hospital admissions from the Nationwide Inpatient Sample (2012-2016). The analysis includes adults (age ≥50) who underwent in-hospital CPR at US community hospitals. RESULTS Overall survival to discharge was 29.8% (95% CI: 29.5-30.1%). Age was the strongest predictor of survival and had greater prognostic value than the Charlson comorbidity index. Obesity was associated with improved survival (35.9%, 95% CI: 35.1-36.7%), whereas underweight patients had decreased survival (24.0%, 95% CI: 22.2-25.7%). Acute indicators of poor survival included hyperkalemia, hypercalcemia, and sepsis. We generated an ABCD index based upon four high-yield variables (age, body habitus, comorbidity, day of hospital admission). An ABCD score of 2 or less was a sensitive but non-specific predictor of post-CPR survival (96.8% sensitivity, 95% CI: 96.6-97.0), and those with extreme scores differed 3.8-fold with respect to post-CPR survival probability (46.0% versus 12.1%). CONCLUSION Age is the strongest predictor of post-CPR survival, but body habitus is also an important indicator that may currently be underutilized. Our results support improved post-CPR survival of obese patients, consistent with an 'obesity paradox'. The ABCD score provides an efficient means of risk-stratifying patients and can be calculated in less than 1 minute.
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Affiliation(s)
- William R Swindell
- Department of Internal Medicine, The Jewish Hospital, Cincinnati, Ohio, USA
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Carrick RT, Park JG, McGinnes HL, Lundquist C, Brown KD, Janes WA, Wessler BS, Kent DM. Clinical Predictive Models of Sudden Cardiac Arrest: A Survey of the Current Science and Analysis of Model Performances. J Am Heart Assoc 2020; 9:e017625. [PMID: 32787675 PMCID: PMC7660807 DOI: 10.1161/jaha.119.017625] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background More than 500 000 sudden cardiac arrests (SCAs) occur annually in the United States. Clinical predictive models (CPMs) may be helpful tools to differentiate between patients who are likely to survive or have good neurologic recovery and those who are not. However, which CPMs are most reliable for discriminating between outcomes in SCA is not known. Methods and Results We performed a systematic review of the literature using the Tufts PACE (Predictive Analytics and Comparative Effectiveness) CPM Registry through February 1, 2020, and identified 81 unique CPMs of SCA and 62 subsequent external validation studies. Initial cardiac rhythm, age, and duration of cardiopulmonary resuscitation were the 3 most commonly used predictive variables. Only 33 of the 81 novel SCA CPMs (41%) were validated at least once. Of 81 novel SCA CPMs, 56 (69%) and 61 of 62 validation studies (98%) reported discrimination, with median c‐statistics of 0.84 and 0.81, respectively. Calibration was reported in only 29 of 62 validation studies (41.9%). For those novel models that both reported discrimination and were validated (26 models), the median percentage change in discrimination was −1.6%. We identified 3 CPMs that had undergone at least 3 external validation studies: the out‐of‐hospital cardiac arrest score (9 validations; median c‐statistic, 0.79), the cardiac arrest hospital prognosis score (6 validations; median c‐statistic, 0.83), and the good outcome following attempted resuscitation score (6 validations; median c‐statistic, 0.76). Conclusions Although only a small number of SCA CPMs have been rigorously validated, the ones that have been demonstrate good discrimination.
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Affiliation(s)
- Richard T Carrick
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Jinny G Park
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Hannah L McGinnes
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Christine Lundquist
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Kristen D Brown
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - W Adam Janes
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Benjamin S Wessler
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
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Nathan AS, Shah RM, Khatana SA, Dayoub E, Chatterjee P, Desai ND, Waldo SW, Yeh RW, Groeneveld PW, Giri J. Effect of Public Reporting on the Utilization of Coronary Angiography After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv 2019; 12:e007564. [PMID: 30998398 PMCID: PMC9123930 DOI: 10.1161/circinterventions.118.007564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Public reporting of cardiovascular outcomes has been associated with risk aversion for potentially lifesaving procedures and may have spillover effects on nonreported but related procedures. METHODS AND RESULTS A cross-sectional analysis of the utilization of coronary angiography among patients presenting with out-of-hospital cardiac arrest between 2005 and 2011 in states with public reporting of percutaneous coronary intervention outcomes (New York and Massachusetts) versus neighboring states without public reporting of percutaneous coronary intervention outcomes (Delaware, Connecticut, Maine, Vermont, Maryland, and Rhode Island) was performed using the Nationwide Inpatient Sample. We analyzed 50 125 admission records with out-of-hospital cardiac arrest between 2005 and 2011. The unadjusted rate of coronary angiography for patients presenting with out-of-hospital cardiac arrest in states with public reporting versus without public reporting was not different (20.8% versus 22.8%, P=0.35). We found no statistically significant difference in the adjusted likelihood of coronary angiography in states with public reporting, though the point estimate suggested decreased utilization (odds ratio, 0.84; 95% CI, 0.66-1.06; P=0.14). There was no difference in the adjusted likelihood of in-hospital mortality for patients presenting with out-of-hospital cardiac arrest in states with public reporting compared to states without public reporting (odds ratio, 0.98; 95% CI, 0.78-1.23; P=0.88). CONCLUSIONS Public reporting of percutaneous coronary intervention outcomes was associated with a nonstatistically significant reduction in the utilization of diagnostic coronary angiography, a nonreported but related procedure, for patients with out-of-hospital cardiac arrest.
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Affiliation(s)
- Ashwin S. Nathan
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
| | | | - Sameed A. Khatana
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
| | - Elias Dayoub
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nimesh D. Desai
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA
| | - Stephen W. Waldo
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Robert W. Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Peter W. Groeneveld
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Jay Giri
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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Wang CH, Chang JL, Huang CH, Chang WT, Tsai MS, Yu PH, Wu YW, Chen WJ, Tseng WK. The association between long-term glycaemic control, glycaemic gap and neurological outcome of in-hospital cardiac arrest in diabetics: A retrospective cohort study. Resuscitation 2018; 133:18-24. [PMID: 30261218 DOI: 10.1016/j.resuscitation.2018.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 12/30/2022]
Abstract
AIM Resuscitation guidelines do not recommend a target blood glucose (BG) level specifically tailored for diabetics experiencing an in-hospital cardiac arrest (IHCA). The glycosylated haemoglobin (HbA1c) level may be associated with neurological prognosis and used to identify the optimal BG level for diabetic IHCA patients. METHODS This study was a retrospective study in a single medical centre. Patients with an IHCA between 2006 and 2015 were screened. The estimated average glucose (eAG) level was converted from the HbA1c level measured within three months prior to the IHCA. The minimum glycaemic gap was calculated from the post-resuscitation minimum BG level minus the eAG level. RESULTS A total of 141 patients were included in this study. The mean HbA1c was 7.2% (corresponding eAG: 160.2 mg/dL [8.9 mmol/L]). Multivariable logistic regression analysis indicated an eAG level of less than 196 mg/dL (10.9 mmol/L; corresponding HbA1c: 8.5%) was positively associated with a favourable neurological outcome at hospital discharge (odds ratio [OR]: 5.12, 95% confidence interval [CI]: 1.11-23.70; p-value = 0.04). An absolute minimum glycaemic gap of less than 70 mg/dL (3.9 mmol/L) was also positively associated with a favourable neurological outcome (OR: 5.41, 95% CI: 1.41-20.78; p-value = 0.01). CONCLUSION For diabetic patients, poor long-term glycaemic control correlated with worse neurological recovery following an IHCA. The HbA1c-derived average BG level could be used as a reference point for glycaemic management during the early stage of post-cardiac arrest syndrome. The glycaemic gap could be used to identify the optimal glycaemic range around the reference point.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jin-Lin Chang
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Hsun Yu
- Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Yen-Wen Wu
- Departments of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Wei-Kung Tseng
- Division of Cardiology, E-DA Hospital, Kaohsiung, Taiwan.
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Aziz F, Paulo MS, Dababneh EH, Loney T. Epidemiology of in-hospital cardiac arrest in Abu Dhabi, United Arab Emirates, 2013-2015. HEART ASIA 2018; 10:e011029. [PMID: 30245746 PMCID: PMC6144902 DOI: 10.1136/heartasia-2018-011029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Abstract
Objective Estimate the incidence and outcomes of in-hospital cardiac arrest (IHCA) in a tertiary-care hospital in Abu Dhabi emirate, United Arab Emirates (UAE). Methods Retrospective data from 685 inpatients who experienced an IHCA at a hospital in Abu Dhabi (UAE) between 1 January 2013 and 31 December 2015 were analysed. Sociodemographic variables were age and gender, and IHCA event variables were shift, day, event location, initial cardiac rhythm and the total number of IHCA events. Outcome variables were the return of spontaneous circulation (ROSC) and survival to discharge (StD). Results The incidence of IHCA was 11.7 (95% CI 10.8 to 12.6) per 1000 hospital admissions. Non-shockable rhythms were 91.1% of the cardiac rhythms at presentation. The majority of IHCA cases occurred in the intensive care unit (46.1%) and on weekdays (74.6%). More than a third (38.3%) of patients who experienced an IHCA achieved ROSC and 7.7% StD. Both ROSC and StD were significantly higher in patients who were younger and presenting with a shockable rhythm (all p’s≤0.05). Survival outcomes were not significantly different between dayshifts and nightshifts or weekdays and weekends. Conclusions The incidence of IHCA was higher and its outcomes were lower compared with other high-income/developed countries. Survival outcomes were better for patients who were younger and had a shockable rhythm, and similar between time of day and days of the week. These findings may help to inform health managers about the magnitude and quality of IHCA care in the UAE.
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Affiliation(s)
- Faisal Aziz
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marilia Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Emad H Dababneh
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tom Loney
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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