Predicting the probability of survival with mild or moderate neurological dysfunction after in-hospital cardiopulmonary arrest: The GO-FAR 2 score

Background: The Good Outcome Following Attempted Resuscitation (GO-FAR) Score uses pre-arrest factors to predict survival after In-Hospital Cardiac Arrest (IHCA) with minimal neurological dysfunction, (cerebral performance category (CPC) <= 1). Moderate neurological dysfunction (CPC <= 2) may be a more acceptable outcome. Objective: To predict survival after IHCA with mild or moderate neurological dysfunction based on pre-arrest factors. Methods: 52,468 patients with IHCA from 2012-2017. Data was divided into training (44%), testing (22%), and validation (34%) sets. Univariate analysis was used to identify variables with >3% difference in survival with CPC <= 2. These variables carried forward to the multivariate logistic regression model. The most parsimonious model that best classified patients as having a very poor (<= 5%), below average (<= 10%), average (11%-30%), or above average (>30 degrees) likelihood of survival with CPC <= 2 was chosen. Results: Age >85, admission CPC <2, and non-surgical admission were strongly association with poor survival (-12.1%, -14.4%, and -18%, respectively). Nine variables were included in the logistic regression analysis. The final updated model, GO FAR 2, categorized 6.2% of patients with a very poor predicted survival, 24.8% of patients with a below average predicted survival, and 11.3% with above average predicted survival. The observed survival among those with very poor predicted survival was 4.5%. Conclusion: The GO FAR 2 score provides clinicians with a prognostic estimate of the likelihood of a good outcome after IHCA based on pre-arrest patient factors. Future research is required to validate the GO-FAR 2 score.