CaRdiac Arrest Survival Score (CRASS) - A tool to predict good neurological outcome after out-of-hospital cardiac arrest

S Seewald; J Wnent; R Lefering; M Fischer; A Bohn; T Jantzen; S Brenner; S Masterson; B Bein; J Scholz; J T Gräsner

doi:10.1016/j.resuscitation.2019.10.036

CaRdiac Arrest Survival Score (CRASS) - A tool to predict good neurological outcome after out-of-hospital cardiac arrest

Resuscitation. 2020 Jan 1:146:66-73. doi: 10.1016/j.resuscitation.2019.10.036. Epub 2019 Nov 12.

Authors

S Seewald¹, J Wnent², R Lefering³, M Fischer⁴, A Bohn⁵, T Jantzen⁶, S Brenner⁷, S Masterson⁸, B Bein⁹, J Scholz¹⁰, J T Gräsner¹¹

Affiliations

¹ Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 12, Kiel, 24105, Germany; Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 808, Kiel, 24105, Germany. Electronic address: seewald@reanimationsregister.de.
² Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 12, Kiel, 24105, Germany; Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 808, Kiel, 24105, Germany; University of Namibia, School of Medicine, Private Bag 13301, Windhoek, Namibia, Germany.
³ University Witten/Herdecke, Faculty of Health, Institute for Research in Operative Medicine, Ostmerheimer Straße 200, Cologne, 51109, Germany.
⁴ Department of Anesthesiology and Intensive Care, Klinik am Eichert, Eichertstraße 3, Göppingen, 73035, Germany.
⁵ City of Münster Fire Department, York-Ring 25, Münster, 48159, Germany; Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, building A1, York-Ring 25, Münster, 48149, Germany.
⁶ Interhospital-Transfer-Service Mecklenburg-Vorpommern, German Red Cross Parchim, Ventschowerstraße 1, Cambs, 19067, Germany.
⁷ Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden, Fetscherstraße 74, Dresden, 01307, Germany.
⁸ National Ambulance Service Lead - Strategy and Evaluation, St. Eunan's Hall, St. Conal's Hospital, Letterkenny, Co. Donegal, Ireland and Discipline of General Practice School of Medicine, National University of Ireland Galway F92 XK84, Ireland.
⁹ Department of Anesthesiology and Intensive Care Medicine, Asklepios Klinik St. Georg, Lohmühlenstraße 5, Hamburg, 20099, Germany.
¹⁰ University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Kiel, 24105, Germany.
¹¹ Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 808, Kiel, 24105, Germany.

PMID: 31730900
DOI: 10.1016/j.resuscitation.2019.10.036

Abstract

Aim: The aim of this study was to develop a score to predict the outcome for patients brought to hospital following out-of-hospital cardiac arrest (OHCA).

Methods: All patients recorded in the German Resuscitation Registry (GRR) who suffered OHCA 2010-2017, who had ROSC or ongoing CPR at hospital admission were included. The study population was divided into development (2010-2016: 7985) and validation dataset (2017: 1806). Binary logistic regression analysis was used to derive the score. The probability of hospital discharge with good neurological outcome was defined as 1/(1 + e^-X), where X is the weighted sum of independent variables.

Results: The following variables were found to have a significant positive (+) or negative (-) impact: age 61-70 years (-0·5), 71-80 (-0·9), 81-90 (-1·3) and > = 91 (-2·3); initial PEA (-0·9) and asystole (-1·4); presumable trauma (-1·1); mechanical CPR (-0·3); application of adrenalin > 0 - < 2 mg (-1·1), 2 - <4 mg (-1·6), 4 - < 6 mg (-2·1), 6 - < 8 mg (-2·5) and > = 8 mg (-2·8); pre emergency status without previous disease (+0·5) or minor disease (+0·2); location at nursing home (-0·6), working place/school (+0·7), doctor's office (+0·7) and public place (+0·3); application of amiodarone (+0·4); hospital admission with ongoing CPR (-1·9) or normotension (+0·4); witnessed arrest (+0·6); time from collapse until start CPR 2 - < 10 min (-0·3) and > = 10 min (-0·5); duration of CPR <5 min (+0·6). The AUC in the development dataset was 0·88 (95% CI 0·87-0·89) and in the validation dataset 0·88 (95% CI 0·86-0·90).

Conclusion: The CaRdiac Arrest Survival Score (CRASS) represents a tool for calculating the probability of survival with good neurological function for patients brought to hospital following OHCA.

Keywords: CaRdiac Arrest Survival Score; German Resuscitation Registry; Out of hospital cardiac arrest.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cardiopulmonary Resuscitation* / methods
Cardiopulmonary Resuscitation* / statistics & numerical data
Female
Germany / epidemiology
Humans
Male
Middle Aged
Nervous System Diseases* / diagnosis
Nervous System Diseases* / epidemiology
Nervous System Diseases* / etiology
Nervous System Diseases* / prevention & control
Out-of-Hospital Cardiac Arrest* / complications
Out-of-Hospital Cardiac Arrest* / epidemiology
Out-of-Hospital Cardiac Arrest* / therapy
Patient Discharge / statistics & numerical data
Predictive Value of Tests
Prognosis
Registries / statistics & numerical data
Retrospective Studies
Risk Factors
Survival Analysis*