External Validation of the CAST and rCAST Score in Patients With Out‐of‐Hospital Cardiac Arrest Who Underwent Extracorporeal Cardiopulmonary Resuscitation: A Secondary Analysis of the SAVE‐J II Study
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Published:2024-01-02
Issue:1
Volume:13
Page:
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ISSN:2047-9980
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Container-title:Journal of the American Heart Association
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language:en
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Short-container-title:JAHA
Author:
Misumi Kayo12ORCID, Hagiwara Yoshihiro1, Kimura Takuya1, Hifumi Toru3ORCID, Inoue Akihiko4, Sakamoto Tetsuya5ORCID, Kuroda Yasuhiro6, Ogura Takayuki1ORCID, Sawano Hirotaka, Egawa Yuko, Kato Shunichi, Sugiyama Kazuhiro, Bunya Naofumi, Kasai Takehiko, Ijuin Shinichi, Nakayama Shinichi, Kanda Jun, Kanou Seiya, Takiguchi Toru, Yokobori Shoji, Takada Hiroaki, Inoue Kazushige, Takeuchi Ichiro, Honzawa Hiroshi, Kobayashi Makoto, Hamagami Tomohiro, Takayama Wataru, Otomo Yasuhiro, Maekawa Kunihiko, Shimizu Takafumi, Nara Satoshi, Nasu Michitaka, Takahashi Kuniko, Fukuda Reo, Shiraishi Shinichiro, Zushi Ryosuke, Otani Norio, Kikuchi Migaku, Watanabe Kazuhiro, Nakagami Takuo, Shoko Tomohisa, Kitamura Nobuya, Otani Takayuki, Matsuoka Yoshinori, Sakuraya Masaaki, Arimoto Hideki, Homma Koichiro, Naito Hiromichi, Nakao Shunichiro, Okazaki Tomoya, Tahara Yoshio, Okamoto Hiroshi, Kunikata Jun, Yokoi Hideto
Affiliation:
1. Department of Emergency and Critical Care Saiseikai Utsunomiya Hospital Utsunomiya Japan 2. Department of Cardiology Saiseikai Utsunomiya Hospital Utsunomiya Japan 3. Department of Emergency and Critical Care Medicine St. Luke’s International Hospital Tokyo Japan 4. Department of Emergency and Critical Care Medicine Hyogo Emergency Medical Center Kobe Japan 5. Department of Emergency Medicine Teikyo University School of Medicine Tokyo Japan 6. Department of Emergency Medicine Kagawa University School of Medicine Miki Kagawa Japan
Abstract
Background
Risk stratification is important in patients with post–cardiac arrest syndrome. The Post‐Cardiac Arrest Syndrome for Therapeutic Hypothermia (CAST) and revised CAST (rCAST) scores have been well validated for predicting neurological outcomes, particularly for conventionally resuscitated patients with post–cardiac arrest syndrome. However, no studies have evaluated patients undergoing extracorporeal cardiopulmonary resuscitation.
Methods and Results
Adult patients with out‐of‐hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation were analyzed in this retrospective observational multicenter cohort study. We validated the accuracy of the CAST/rCAST scores for predicting neurological outcomes at 30 days. Moreover, we compared the predictive performance of these scores with the TiPS65 risk score derived from patients with out‐of‐hospital cardiac arrest who were resuscitated using extracorporeal cardiopulmonary resuscitation. A total of 1135 patients were analyzed. The proportion of patients with favorable neurological outcomes was 16.6%. In the external validation, the area under the receiver operating characteristic curve of the CAST score was significantly higher than that of the rCAST score (area under the receiver operating characteristic curve 0.677 versus 0.603;
P
<0.001), but there was no significant difference with that of the TiPS65 score (versus 0.633;
P
=0.154). Both CAST/rCAST risk scores showed good calibration (Hosmer–Lemeshow test:
P
=0.726 and 0.674), and the CAST score showed significantly better predictability in net reclassification compared with the rCAST (
P
<0.001) and TiPS65 scores (
P
=0.001).
Conclusions
The prognostic accuracy of the CAST score was significantly better than that of other risk scores in net reclassification. The CAST score may help to predict neurological outcomes in patients with out‐of‐hospital cardiac arrest who undergo extracorporeal cardiopulmonary resuscitation. However, the predictive value of the CAST score was not sufficiently high for clinical application.
Registration
URL:
https://center6.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000041577
; Unique identifier: UMIN000036490.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
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