Prediction protocol for neurological outcome for survivors of out-of-hospital cardiac arrest treated with targeted temperature management

Aim: To identify patients who can obtain the full benefit from targeted temperature management (TTM) after out-of-hospital cardiac arrest. Methods: We performed a retrospective observational study of comatose patients treated with TTM after an out-of-hospital cardiac arrest from January 2006 to February 2011. Neurological outcome was evaluated with the Glasgow-Pittsburgh Cerebral Performance category (CPC) at discharge and predictors were determined. Results: Of 66 patients studied, 40 (60.6%) survived to neurologically intact discharge (CPC 1 or 2). According to multivariate analysis, predictors of good neurological outcome included arrest-to-first cardiopulmonary resuscitation attempt interval <= 5 min, ventricular fibrillation or ventricular tachycardia in the first monitored rhythm, absence of re-arrest before leaving the emergency department, arrest-to- return of spontaneous circulation interval <= 30 min and recovery of pupillary light reflex, which were identifiable in the emergency department. Based on this analysis, we developed a seven-point score (5-R score). If the score was >= 5, it predicted good neurological outcome with a sensitivity of 82.5% (95% confidence interval [CI], 67.2-92.7%) and specificity of 92.3% (95% CI, 74.9-99.1%). The negative predictive value of a score >= 4 was 100% (95% CI, 81.5-100%). Our prediction model was validated internally by a bootstrapping technique. Conclusions: The prediction protocol using the 5-R score was associated with good neurological outcome of patients treated with TTM. Therefore, it could be helpful in clinical decision making on whether to initiate cooling. (C) 2012 Elsevier Ireland Ltd. All rights reserved.