• Resuscitation · Jul 2018

    Predicting neurologically intact survival after in-hospital cardiac arrest-external validation of the Good Outcome Following Attempted Resuscitation score.

    • Eva Piscator, Katarina Göransson, Samuel Bruchfeld, Ulf Hammar, Sara El Gharbi, Mark Ebell, Johan Herlitz, and Therese Djärv.
    • Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Karolinska University Hospital, Stockholm, Sweden. Electronic address: eva.piscator@ki.se.
    • Resuscitation. 2018 Jul 1; 128: 63-69.

    BackgroundA do-not-attempt-resuscitation order is issued when it is against the wishes of the patient that cardiopulmonary resuscitation is performed, or when the chance of good quality survival is minimal. Therefore it is essential for physicians to make an objective prearrest prediction of the outcome after an in-hospital cardiac arrest (IHCA). Our aim was external validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in a population based setting.MethodsThe study was based on a retrospective cohort of adult IHCAs in Stockholm County 2013-2014 identified through the Swedish Cardiopulmonary Resuscitation Registry. This registry provided patient and event characteristics and neurological outcome at discharge. Neurologically intact survival is defined as Cerebral Performance Category score (CPC) 1 at discharge. Data for the GO-FAR variables was obtained from manual review of electronic patient records. Model performance was evaluated by measure of discrimination with the area under the receiver operating curve (AUROC) and calibration with assessment of the calibration plot.ResultsThe cohort included 717 patients with neurologically intact survival at discharge of 22%. In complete case analysis (523 cases) AUROC was 0.82 (95% CI 0.78-0.86) indicating good discrimination. The calibration plot showed that the GO-FAR score systematically underestimates the probability of neurologically intact survival.ConclusionThe GO-FAR score has satisfactory discrimination, but assessment of the calibration shows that neurologically intact survival is systematically underestimated. Therefore, only with caution should it without model update be taken into clinical practice in settings similar to ours.Copyright © 2018 Elsevier B.V. All rights reserved.

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