PMID- 33231635 OWN - NLM STAT- MEDLINE DCOM- 20210114 LR - 20210114 IS - 2574-3805 (Electronic) IS - 2574-3805 (Linking) VI - 3 IP - 11 DP - 2020 Nov 2 TI - Development and Validation of a Clinical Score to Predict Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation. PG - e2022920 LID - 10.1001/jamanetworkopen.2020.22920 [doi] LID - e2022920 AB - IMPORTANCE: Extracorporeal cardiopulmonary resuscitation (ECPR) is expected to improve the neurological outcomes of patients with refractory cardiac arrest; however, it is invasive, expensive, and requires substantial human resources. The ability to predict neurological outcomes would assist in patient selection for ECPR. OBJECTIVE: To develop and validate a prediction model for neurological outcomes of patients with out-of-hospital cardiac arrest with shockable rhythm treated with ECPR. DESIGN, SETTING, AND PARTICIPANTS: This prognostic study analyzed data from the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest registry, a multi-institutional nationwide cohort study that included 87 emergency departments in Japan. All adult patients with out-of-hospital cardiac arrest and shockable rhythm who were treated with ECPR between June 2014 and December 2017 were included. Patients were randomly assigned to the development and validation cohorts based on the institutions. The analysis was conducted between November 2019 and August 2020. EXPOSURES: Age (<65 years), time from call to hospital arrival (/=7.0). MAIN OUTCOMES AND MEASURES: The primary outcome was 1-month survival with favorable neurological outcome, defined by Cerebral Performance Category 1 or 2. In the development cohort, a simple scoring system was developed to predict this outcome using a logistic regression model. The diagnostic ability and calibration of the scoring system were assessed in the validation cohort. RESULTS: A total of 916 patients were included, 458 in the development cohort (median [interquartile range IQR] age, 61 [47-69] years, 377 [82.3%] men) and 458 in the validation cohort (median [IQR] age, 60 [49-68] years; 393 [85.8%] men). The cohorts had the same proportion of favorable neurological outcome (57 patients [12.4%]). The prediction scoring system was developed, attributing a score of 1 for each clinical predictor. Patients were divided into 4 groups, corresponding to their scores on the prediction model, as follows: very low probability (score 0), low probability (score 1), middle probability (score 2), and high probability (score 3-4) of good neurological outcome. The mean predicted probabilities in the groups stratified by score were as follows: very low, 1.6% (95% CI, 1.6%-1.6%); low, 4.4% (95% CI, 4.2%-4.6%); middle, 12.5% (95% CI, 12.1%-12.8%); and high, 30.8% (95% CI, 29.1%-32.5%). In the validation cohort, the C statistic of the scoring system was 0.724 (95% CI, 0.652-0.786). The predicted probability was evaluated as well calibrated to the observed favorable outcome in both cohorts by visual assessment of the calibration plot. CONCLUSIONS AND RELEVANCE: In this study, the scoring system had good discrimination and calibration performance to predict favorable neurological outcomes of patients with out-of-hospital cardiac arrest and shockable rhythm who were treated with ECPR. FAU - Okada, Yohei AU - Okada Y AD - Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan. AD - Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. FAU - Kiguchi, Takeyuki AU - Kiguchi T AD - Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan. AD - Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan. FAU - Irisawa, Taro AU - Irisawa T AD - Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan. FAU - Yamada, Tomoki AU - Yamada T AD - Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan. FAU - Yoshiya, Kazuhisa AU - Yoshiya K AD - Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan. FAU - Park, Changhwi AU - Park C AD - Department of Emergency Medicine, Tane General Hospital, Osaka, Japan. FAU - Nishimura, Tetsuro AU - Nishimura T AD - Department of Critical Care Medicine, Osaka City University, Osaka, Japan. FAU - Ishibe, Takuya AU - Ishibe T AD - Department of Emergency and Critical Care Medicine, Kindai University School of Medicine, Osaka-Sayama, Japan. FAU - Yagi, Yoshiki AU - Yagi Y AD - Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan. FAU - Kishimoto, Masafumi AU - Kishimoto M AD - Senshu Trauma and Critical Care Center, Osaka, Japan. FAU - Inoue, Toshiya AU - Inoue T AD - Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan. FAU - Hayashi, Yasuyuki AU - Hayashi Y AD - Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan. FAU - Sogabe, Taku AU - Sogabe T AD - Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan. FAU - Morooka, Takaya AU - Morooka T AD - Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan. FAU - Sakamoto, Haruko AU - Sakamoto H AD - Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Osaka, Japan. FAU - Suzuki, Keitaro AU - Suzuki K AD - Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan. FAU - Nakamura, Fumiko AU - Nakamura F AD - Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan. FAU - Matsuyama, Tasuku AU - Matsuyama T AD - Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan. FAU - Nishioka, Norihiro AU - Nishioka N AD - Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan. FAU - Kobayashi, Daisuke AU - Kobayashi D AD - Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan. FAU - Matsui, Satoshi AU - Matsui S AD - Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. FAU - Hirayama, Atsushi AU - Hirayama A AD - Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. FAU - Yoshimura, Satoshi AU - Yoshimura S AD - Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan. FAU - Kimata, Shunsuke AU - Kimata S AD - Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan. FAU - Shimazu, Takeshi AU - Shimazu T AD - Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan. FAU - Ohtsuru, Shigeru AU - Ohtsuru S AD - Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. FAU - Kitamura, Tetsuhisa AU - Kitamura T AD - Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. FAU - Iwami, Taku AU - Iwami T AD - Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan. LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't PT - Validation Study DEP - 20201102 PL - United States TA - JAMA Netw Open JT - JAMA network open JID - 101729235 SB - IM MH - Adult MH - Aged MH - Cardiopulmonary Resuscitation/methods MH - Extracorporeal Membrane Oxygenation/*methods/mortality MH - Female MH - Humans MH - Japan/epidemiology MH - Male MH - Middle Aged MH - Out-of-Hospital Cardiac Arrest/mortality/*therapy MH - Random Allocation MH - Registries MH - Reproducibility of Results MH - Retrospective Studies MH - Risk Assessment/*methods MH - Time-to-Treatment/statistics & numerical data PMC - PMC7686862 COIS- Conflict of Interest Disclosures: None reported. EDAT- 2020/11/25 06:00 MHDA- 2021/01/15 06:00 PMCR- 2020/11/24 CRDT- 2020/11/24 12:11 PHST- 2020/11/24 12:11 [entrez] PHST- 2020/11/25 06:00 [pubmed] PHST- 2021/01/15 06:00 [medline] PHST- 2020/11/24 00:00 [pmc-release] AID - 2773395 [pii] AID - zoi200768 [pii] AID - 10.1001/jamanetworkopen.2020.22920 [doi] PST - epublish SO - JAMA Netw Open. 2020 Nov 2;3(11):e2022920. doi: 10.1001/jamanetworkopen.2020.22920.