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Glasgow Coma Scale score of more than four on admission predicts in-hospital survival in patients after out-of-hospital cardiac arrest

Published:January 15, 2021DOI:https://doi.org/10.1016/j.ajem.2021.01.018

      Abstract

      Aim

      The aim of the study was to assess the usefulness of the Glasgow Coma Scale (GCS) score assessed by EMS team in predicting survival to hospital discharge in patients after out-of-hospital cardiac arrest (OHCA).

      Methods

      Silesian Registry of OHCA (SIL-OHCA) is a prospective, population-based regional registry of OHCAs. All cases of OHCAs between the 1st of January 2018 and the 31st of December 2018 were included. Data were collected by EMS using a paper-based, Utstein-style form. OHCA patients aged ≥18 years, with CPR attempted or continued by EMS, who survived to hospital admission, were included in the current analysis. Patients who did not achieve return of spontaneous circulation (ROSC) in the field, with missing data on GCS after ROSC or survival status at discharge were excluded from the study.

      Results

      Two hundred eighteen patients with OHCA, who achieved ROSC, were included in the present analysis. ROC analysis revealed GCS = 4 as a cut-off value in predicting survival to discharge (AUC 0.735; 95%CI 0.655–0.816; p < 0.001). Variables significantly associated with in-hospital survival were young age, short response time, witnessed event, previous myocardial infarction, chest pain before OHCA, initial shockable rhythm, coronary angiography, and GCS > 4. On the other hand, epinephrine administration, intubation, the need for dispatching two ambulances, and/or a physician-staffed ambulance were associated with a worse prognosis. Multivariable logistic regression analysis revealed GCS > 4 as an independent predictor of in-hospital survival after OHCA (OR of 6.4; 95% CI 2.0–20.3; p < 0.0001). Other independent predictors of survival were the lack of epinephrine administration, previous myocardial infarction, coronary angiography, and the patient's age.

      Conclusion

      The survival to hospital discharge after OHCA could be predicted by the GCS score on hospital admission.

      Keywords

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      References

        • Berdowski J.
        • Berg R.A.
        • Tigissen J.G.
        • Koster R.W.
        Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies.
        Resuscitation. 2010; 81: 1479-1487
        • Nadolny K.
        • Zyśko D.
        • Obremska M.
        • Wierzbik-Strońska M.
        • Ładny J.R.
        • Podgórski M.
        • et al.
        Analysis of out-of-hospital cardiac arrest in Poland in a 1-year period: data from the POL-OHCA registry.
        Kardiol Pol. 2020; 78: 404-411
        • Grasner J.T.
        • Herlitz J.
        • Koster R.W.
        • Rosell-Oritz F.
        • Stamatakis L.
        • Bossaert L.
        Quality management in resuscitation-towards a European cardiac agrest registry (EuReCa).
        Reuscitation. 2011; 82: 989-994
        • Bigham S.
        • Bigham C.
        • Martin D.
        Predictors of outcome post cardiac arrest.
        J Intensive Care Med. 2018; 33: 248-255
      1. McNally B, Robb R, Mehta M, Vellano K, Valderrama AL, Yoon PW, et.al. Centers for Disease Control and Prevention. Out-of-hospital cardiac arrest surveillance --- cardiac arrest registry to enhance survival (CARES), United States, October 1, 2005—December 31, 2010. MMWR Surveill Summ 2011; 60 :1–19.

        • Corrada E.
        • Mennuni M.G.
        • Grieco N.
        • Sesana G.
        • Beretta G.
        • Presbitero P.
        Neurological recovery after out-of-hospital cardiac arrest: hospital admission predictors and one-year survival in an urban cardiac network experience.
        Minerva Cardioangiol. 2013; 61: 451-460
        • Al Hasan D.
        • Yaseen A.
        • El Sayed M.
        Epidemiology and outcomes from out-of-hospital cardiac arrest in Kuwait.
        Emerg Med Int. 2020; 2020: 9861798
        • Weisfeldt M.
        • Becker L.
        Resuscitation after cardiac arrest: a 3-phase time-sensitive model.
        JAMA. 2002; 288: 3035-3038
        • Shemie S.D.
        • Gardiner D.
        Circulatory Arrest, Brain Arrest and Death Determination.
        Front Cardiovasc Med. 2018; 13: 15
        • Kurowski A.
        • Szarpak Ł.
        The use of GCS in the assessment of patients with head injuries.
        Na Ratunek. 2010; 2: 30-32
        • Soar J.
        • Nolan J.P.
        • Böttiger B.W.
        • Perkins G.D.
        • Lott C.
        • Carli P.
        • et al.
        European resuscitation council guidelines for resuscitation 2015: section 3. Adult advanced life support.
        Resuscitation. 2015; 95: 100-147
        • Link M.S.
        • Berkow L.C.
        • Kudenchuk P.J.
        • Halperin H.R.
        • Hess E.P.
        • Moitra V.K.
        • et al.
        Part 7: adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132: S444-S464
        • Perkins G.D.
        • Jacobs I.G.
        • Nadkarni V.M.
        • Berg R.A.
        • Bhanji F.
        • Biarent D.
        • et al.
        Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the international liaison committee.
        Resuscitation. 2015; 96: 328-340
        • Nadolny K.
        • Bujak K.
        • Kucap M.
        • Trzeciak P.
        • Hudzik B.
        • Borowicz A.
        • et al.
        The Silesian registry of out-of-hospital cardiac arrest: study design and results of a three-month pilot study.
        Cardiol J. 2020; 27: 566-574
        • Martinell L.
        • Nielsen N.
        • Herlitz J.
        • Karlsson T.
        • Horn J.
        • Wise M.P.
        Early predictors of poor outcome after out-of-hospital cardiac arrest.
        Crit Care. 2017; 13: 96
        • Guy A.
        • Kawano T.
        • Besserer F.
        • Scheuermeyer F.
        • Kanji H.D.
        • Christenson J.
        • et al.
        The relationship between no-flow interval and survival with favourable neurological outcome in out-of-hospital cardiac arrest: Implications for outcomes and ECPR eligibility.
        Resuscitation. 2020; 115: 219-225
        • Welbourn C.
        • Efstathiou N.
        How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving cardiac arrest?.
        A systematic review Scand J Trauma Resusc Emerg Med. 2018; 26: 77
        • Kvakkestad K.M.
        • Sandvik L.
        • Andersen G.Ø.
        • Sunde K.
        • Halvorsen S.
        Long-term survival in patients with acute myocardial infarction and out-of-hospital cardiac arrest: a prospective cohort study.
        Resuscitation. 2018; : 41-47
        • Morrison L.J.
        Prehospital termination of resuscitation rule.
        Curr Opin Crit Care. 2019; 25: 199-203
        • Boyce L.W.
        • Vliet Vlieland T.P.
        • Bosch J.
        • Wolterbeek R.
        • Volker G.
        • Van Exel H.J.
        • et al.
        High survival rate of 43% in out-of-hospital cardiac arrest patients in an optimised chain of survival.
        Neth Heart J. 2015; 23: 20-25
        • Hifumi T.
        • Kuroda Y.
        • Kawakita K.
        • Sawano H.
        • Tahara Y.
        • Hase M.
        • et al.
        J-PULSE-hypo investigators. Effect of admission Glasgow coma scale motor score on neurological outcome in out-of- hospital cardiac arrest patients receiving therapeutic hypothermia.
        Circ J. 2015; 79: 2201-2208
        • Khan A.J.
        • Liao C.J.
        • Kabir C.H.
        • Hallak O.
        • Samee M.
        • Potts S.
        • et al.
        Etiology and Determinants of In-Hospital Survival in Patients Resuscitated After Out-of-Hospital Cardiac Arrest in An Urban Medical Center.
        The American Journal of Cardiology. 2020; 130: 78-84
      2. Kołtowski Ł, Średniawa B, Tycińska A, Czajkowska M, Niedziela M, Puchalski W, et al. Predicting survival in out-of-hospital cardiac arrest patients undergoing targeted temperature management: The Polish Hypothermia Registry Risk Score. Cardiol J. 2019. doi: https://doi.org/10.5603/CJ.a2019.0035 [online ahead of print].

        • Umińska J.M.
        • Ratajczak J.
        • Buszko K.
        • Sobczak P.
        • Sroka W.
        • Marszałł M.P.
        • et al.
        Impact of mild therapeutic hypothermia on bioavailability of ticagrelor in patients with acute myocardial infarction after out-of-hospital cardiac arrest.
        Cardiol J. 2019; ([online ahead of print])https://doi.org/10.5603/CJ.a2019.0024
        • Ratajczak J.
        • Łach P.
        • Umińska J.
        • Pstrągowski K.
        • Kasprzak M.
        • Fabiszak T.
        • et al.
        Mild therapeutic hypothermia after out-of-hospital cardiac arrest: What does really matter?.
        Cardiol J. 2019; ([online ahead of print])https://doi.org/10.5603/CJ.a2019.0023
        • Kurowski A.
        • Szarpak Ł.
        • Frass M.
        • Samarin S.
        • Czyzewski Ł.
        Glasgow coma scale used as a prognostic factor in unconscious patients following cardiac arrest in prehospital situations: preliminary data.
        Am J Emerg Med. 2016; 34: 1178-1179
        • Sondergaard K.B.
        • Riddersholm S.
        • Wissenberg M.
        • Moller Hansen S.
        • Barcella C.A.
        • Karlsson L.
        • et al.
        Out-of-hospital cardiac arrest: 30-day survival and 1-year risk of anoxic brain damage or nursing home admission according to consciousness status at hospital arrival.
        Resuscitation. 2020; 148: 251-258
        • Reith F.C.M.
        • Van den Brande R.
        • Synnot A.
        • et al.
        The reliability of the Glasgow coma scale: a systematic review.
        Intensive Care Med. 2016; 42: 3-15
      3. Feldman A, Hart KW, Lindsell CJ, McMullan JT. Randomized controlled trial of a scoring aid to improve Glasgow Coma Scale scoring by emergency medical services providers. Ann Emerg Med. 2015; 65:325–329.e2. doi: https://doi.org/10.1016/j.annemergmed.2014.07.454. Epub 2014.