Prospective comparison of prognostic scores for prediction of outcome after out-of-hospital cardiac arrest: results of the AfterROSC1 multicentric study

Jean Baptiste Lascarrou (1, 2, 3, 4) , Wulfran Bougouin (4, 3, 5) , Jonathan Chelly (6, 3) , Jeremy Bourenne (7, 3) , Cedric Daubin (8, 3) , Olivier Lesieur (3, 9) , Pierre Asfar (10, 3) , Gwenhael Colin (11, 3) , Marine Paul (12, 3) , Nicolas Chudeau (13, 3) , Gregoire Muller (14, 3) , Guillaume Geri (15, 3, 16) , Sophier Jacquier (3, 17) , Nicolas Pichon (3, 18) , Thomas Klein (19, 20, 3) , Bertrand Sauneuf (3, 21) , Kada Klouche (22, 23, 3) , Martin Cour (24, 3) , Caroline Sejourne (25, 3) , Filippo Annoni (3, 26) , Jean-Herle Raphalen (3, 27) , Arnaud Galbois (3, 28) , Cedric Bruel (3, 29) , Nicolas Mongardon (3, 30) , Nadia Aissaoui (3, 31) , Nicolas Deye (3, 32) , Julien Maizel (33, 34, 3) , Florence Dumas (35) , Stephane Legriel (3, 12) , Alain Cariou (3, 35) , Noémie Peres , Audrey Le Saux , Mathieu Bellal , Maxime Leloup , Paul Jaubert , Matthieu Henry-Lagarrigue , Nina Alezra , Juliette Meunier , Mai-Anh Nay , Charlotte Salmon-Gandonnière , Sandrine Mons , Bruno Levy , Xavier Souloy , Laura Platon , Laurent Argaud , Fabio Taccone , Damien Vimpere , Riad Chelha , Quentin de Roux , Caroline Hauw Berlemont , Bruno Megarbane , Sarah Benghanem , Jeremie Lemarie , Cyril Goulenok

1 MIP - Motricité, interactions, performance UR 4334 / Movement - Interactions - Performance
2 CHU Nantes - Centre Hospitalier Universitaire de Nantes
3 AfterROSC Network Group [Paris]
4 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
5 Hôpital Privé Jacques Cartier [Massy]
6 Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse
7 TIMONE - Hôpital de la Timone [CHU - APHM]
8 Service de Soins Intensifs [CHU Caen]
9 Groupe hospitalier de La Rochelle
10 CHU Angers - Centre Hospitalier Universitaire d'Angers
11 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
12 CHV - Centre Hospitalier de Versailles André Mignot
13 Centre Hospitalier Le Mans (CH Le Mans)
14 CHRO - Centre Hospitalier Régional d'Orléans
15 CESP - Centre de recherche en épidémiologie et santé des populations
16 Hôpital Ambroise Paré [AP-HP]
17 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
18 CH Brive - Centre Hospitalier de Brive-la-Gaillarde
19 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
20 Service d'Anesthésie et Réanimation [CHRU Nancy]
21 CHPC - CH Centre Hospitalier Public du Cotentin
22 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
23 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
24 HCL - Hospices Civils de Lyon
25 CH Béthune - Centre Hospitalier de Béthune
26 Hôpital Erasme [Bruxelles]
27 Hôpital Necker - Enfants Malades [AP-HP]
28 Centre Hospitalier Privé Claude Galien - Ramsay Santé
29 hpsj - Groupe Hospitalier Paris Saint-Joseph
30 Hôpital Henri Mondor
31 HEGP - Hôpital Européen Georges Pompidou [APHP]
32 Hôpital Lariboisière-Fernand-Widal [APHP]
33 CHU Amiens-Picardie
34 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
35 Hôpital Cochin [AP-HP]

Background Out-of-hospital cardiac arrest (OHCA) is a heterogeneous entity with multiple origins and prognoses. An early, reliable assessment of the prognosis is useful to adapt therapeutic strategy, tailor intensity of care, and inform relatives. We aimed primarily to undertake a prospective multicentric study to evaluate predictive performance of the Cardiac Arrest Prognosis (CAHP) Score as compare to historical dataset systematically collected after OHCA (Utstein style criteria). Our secondary aim was to evaluate other dedicated scores for predicting outcome after OHCA and to compare them to Utstein style criteria. Methods We prospectively collected data from 24 French and Belgium Intensive Care Units (ICUs) between August 2020 and June 2022. All cases of non-traumatic OHCA (cardiac and non-cardiac causes) patients with stable return of spontaneous circulation (ROSC) and comatose at ICU admission (defined by Glasgow coma score ≤ 8) on ICU admission were included. The primary outcome was the modified Rankin scale (mRS) at day 90 after cardiac arrest, assessed by phone interviews. A wide range of developed scores (CAHP, OHCA, CREST, C-Graph, TTM, CAST, NULL-PLEASE, and MIRACLE2) were included, and their accuracies in predicting poor outcome at 90 days after OHCA (defined as mRS ≥ 4) were determined using the area under the receiving operating characteristic curve (AUROC) and the calibration belt. Results During the study period, 907 patients were screened, and 658 were included in the study. Patients were predominantly male (72%), with a mean age of 61 ± 15, most having collapsed from a supposed cardiac cause (64%). The mortality rate at day 90 was 63% and unfavorable neurological outcomes were observed in 66%. The performance (AUROC) of Utstein criteria for poor outcome prediction was moderate at 0.79 [0.76–0.83], whereas AUROCs from other scores varied from 0.79 [0.75–0.83] to 0.88 [0.86–0.91]. For each score, the proportion of patients for whom individual values could not be calculated varied from 1.4% to 17.4%. Conclusions In patients admitted to ICUs after a successfully resuscitated OHCA, most of the scores available for the evaluation of the subsequent prognosis are more efficient than the usual Utstein criteria but calibration is unacceptable for some of them. Our results show that some scores (CAHP, sCAHP, mCAHP, OHCA, rCAST) have superior performance, and that their ease and speed of determination should encourage their use. Trial registration https://clinicaltrials.gov/ct2/show/NCT04167891

Mots clés: Cardiac arrest; Functional outcome; Neurological prognosis; Outcome prediction; Score

Domaines: Médecine humaine et pathologie

Jean Baptiste Lascarrou, Wulfran Bougouin, Jonathan Chelly, Jeremy Bourenne, Cedric Daubin, et al.. Prospective comparison of prognostic scores for prediction of outcome after out-of-hospital cardiac arrest: results of the AfterROSC1 multicentric study. Annals of Intensive Care, 2023, 13 (1), pp.100. ⟨10.1186/s13613-023-01195-w⟩. ⟨hal-04247479⟩