Prospective comparison of prognostic scores for prediction of outcome after out-of-hospital cardiac arrest: results of the AfterROSC1 multicentric study
Authors: Lascarrou Jean Baptiste , Bougouin Wulfran , Chelly Jonathan , Bourenne Jeremy , Daubin Cedric , Lesieur Olivier , Asfar Pierre , Colin Gwenhael , Paul Marine , Chudeau Nicolas , Muller Gregoire , Geri Guillaume , Jacquier Sophier , Pichon Nicolas , Klein Thomas , Sauneuf Bertrand , Klouche Kada , Cour Martin , Sejourne Caroline , Annoni Filippo , Raphalen Jean-Herle , Galbois Arnaud , Bruel Cedric , Mongardon Nicolas , Aissaoui Nadia , Deye Nicolas , Maizel Julien , Dumas Florence , Legriel Stephane , Cariou Alain ,   the AfterROSC Network, Peres Noémie , Le Saux Audrey , Bellal Mathieu , Leloup Maxime , Jaubert Paul , Henry-Lagarrigue Matthieu , Alezra Nina , Meunier Juliette , Nay Mai-Anh , Salmon-Gandonnière Charlotte , Mons Sandrine , Levy Bruno , Souloy Xavier , Platon Laura , Argaud Laurent , Taccone Fabio , Vimpere Damien , Chelha Riad , de Roux Quentin , Berlemont Caroline Hauw , Megarbane Bruno , Benghanem Sarah , Lemarie Jeremie , Goulenok Cyril 
Published: October 2023

Abstract
Background
Out-of-hospital cardiac arrest (OHCA) is a heterogeneous entity with multiple origins and prognoses. An early, reliable assessment of the prognosis is useful to adapt therapeutic strategy, tailor intensity of care, and inform relatives. We aimed primarily to undertake a prospective multicentric study to evaluate predictive performance of the Cardiac Arrest Prognosis (CAHP) Score as compare to historical dataset systematically collected after OHCA (Utstein style criteria). Our secondary aim was to evaluate other dedicated scores for predicting outcome after OHCA and to compare them to Utstein style criteria.

Methods
We prospectively collected data from 24 French and Belgium Intensive Care Units (ICUs) between August 2020 and June 2022. All cases of non-traumatic OHCA (cardiac and non-cardiac causes) patients with stable return of spontaneous circulation (ROSC) and comatose at ICU admission (defined by Glasgow coma score ≤ 8) on ICU admission were included. The primary outcome was the modified Rankin scale (mRS) at day 90 after cardiac arrest, assessed by phone interviews. A wide range of developed scores (CAHP, OHCA, CREST, C-Graph, TTM, CAST, NULL-PLEASE, and MIRACLE2) were included, and their accuracies in predicting poor outcome at 90 days after OHCA (defined as mRS ≥ 4) were determined using the area under the receiving operating characteristic curve (AUROC) and the calibration belt.

Results
During the study period, 907 patients were screened, and 658 were included in the study. Patients were predominantly male (72%), with a mean age of 61 ± 15, most having collapsed from a supposed cardiac cause (64%). The mortality rate at day 90 was 63% and unfavorable neurological outcomes were observed in 66%. The performance (AUROC) of Utstein criteria for poor outcome prediction was moderate at 0.79 [0.76–0.83], whereas AUROCs from other scores varied from 0.79 [0.75–0.83] to 0.88 [0.86–0.91]. For each score, the proportion of patients for whom individual values could not be calculated varied from 1.4% to 17.4%.

Conclusions
In patients admitted to ICUs after a successfully resuscitated OHCA, most of the scores available for the evaluation of the subsequent prognosis are more efficient than the usual Utstein criteria but calibration is unacceptable for some of them. Our results show that some scores (CAHP, sCAHP, mCAHP, OHCA, rCAST) have superior performance, and that their ease and speed of determination should encourage their use.
Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04167891