Patrick J Coppler1, Jonathan Elmer2, Luis Calderon3, Alexa Sabedra3, Ankur A Doshi3, Clifton W Callaway4, Jon C Rittenberger3, Cameron Dezfulian5. 1. Safar Center for Resuscitation Research, University of Pittsburgh, United States; Department of Critical Care Medicine, University of Pittsburgh, United States. 2. Department of Emergency Medicine, University of Pittsburgh, United States; Department of Critical Care Medicine, University of Pittsburgh, United States. 3. Department of Emergency Medicine, University of Pittsburgh, United States. 4. Safar Center for Resuscitation Research, University of Pittsburgh, United States; Department of Emergency Medicine, University of Pittsburgh, United States; Department of Pharmacology and Chemical Biology, University of Pittsburgh, United States. 5. Safar Center for Resuscitation Research, University of Pittsburgh, United States; Department of Critical Care Medicine, University of Pittsburgh, United States; Vascular Medicine Institute, University of Pittsburgh, United States. Electronic address: dezfulianc@upmc.edu.
Abstract
BACKGROUND: The purpose of this study was to validate the ability of an early post-cardiac arrest illness severity classification to predict patient outcomes. METHODS: The Pittsburgh Cardiac Arrest Category (PCAC) is a 4-level illness severity score that was found to be strongly predictive of outcomes in the initial derivation study. We assigned PCAC scores to consecutive in and out-of-hospital cardiac arrest subjects treated at two tertiary care centers between January 2011 and September 2013. We made assignments prospectively at Site 1 and retrospectively at Site 2. Our primary outcome was survival to hospital discharge. Inter-rater reliability of retrospective PCAC assessments was assessed. Secondary outcomes were favorable discharge disposition (home or acute rehabilitation), Cerebral Performance Category (CPC) and modified Rankin Scale (mRS) at hospital discharge. We tested the association of PCAC with each outcome using unadjusted and multivariable logistic regression. RESULTS: We included 607 cardiac arrest patients during the study (393 at Site 1 and 214 at Site 2). Site populations differed in age, arrest location, rhythm, use of hypothermia and distribution of PCAC. Inter-rater reliability of retrospective PCAC assignments was excellent (κ=0.81). PCAC was associated with survival (unadjusted odds ratio (OR) for Site 1: 0.33 (95% confidence interval (CI) 0.27-0.41)) Site 2: 0.32 (95% CI 0.24-0.43) even after adjustment for other clinical variables (adjusted OR Site 1: 0.32 (95% CI 0.25-0.41) Site 2: 0.31 (95% CI 0.22-0.44)). PCAC was predictive of secondary outcomes. CONCLUSIONS: Our results confirm that PCAC is strongly predictive of survival and good functional outcome after cardiac arrest.
BACKGROUND: The purpose of this study was to validate the ability of an early post-cardiac arrest illness severity classification to predict patient outcomes. METHODS: The Pittsburgh Cardiac Arrest Category (PCAC) is a 4-level illness severity score that was found to be strongly predictive of outcomes in the initial derivation study. We assigned PCAC scores to consecutive in and out-of-hospital cardiac arrest subjects treated at two tertiary care centers between January 2011 and September 2013. We made assignments prospectively at Site 1 and retrospectively at Site 2. Our primary outcome was survival to hospital discharge. Inter-rater reliability of retrospective PCAC assessments was assessed. Secondary outcomes were favorable discharge disposition (home or acute rehabilitation), Cerebral Performance Category (CPC) and modified Rankin Scale (mRS) at hospital discharge. We tested the association of PCAC with each outcome using unadjusted and multivariable logistic regression. RESULTS: We included 607 cardiac arrestpatients during the study (393 at Site 1 and 214 at Site 2). Site populations differed in age, arrest location, rhythm, use of hypothermia and distribution of PCAC. Inter-rater reliability of retrospective PCAC assignments was excellent (κ=0.81). PCAC was associated with survival (unadjusted odds ratio (OR) for Site 1: 0.33 (95% confidence interval (CI) 0.27-0.41)) Site 2: 0.32 (95% CI 0.24-0.43) even after adjustment for other clinical variables (adjusted OR Site 1: 0.32 (95% CI 0.25-0.41) Site 2: 0.31 (95% CI 0.22-0.44)). PCAC was predictive of secondary outcomes. CONCLUSIONS: Our results confirm that PCAC is strongly predictive of survival and good functional outcome after cardiac arrest.
Authors: Paul S Chan; John A Spertus; Harlan M Krumholz; Robert A Berg; Yan Li; Comilla Sasson; Brahmajee K Nallamothu Journal: Arch Intern Med Date: 2012-06-25
Authors: Vinay M Nadkarni; Gregory Luke Larkin; Mary Ann Peberdy; Scott M Carey; William Kaye; Mary E Mancini; Graham Nichol; Tanya Lane-Truitt; Jerry Potts; Joseph P Ornato; Robert A Berg Journal: JAMA Date: 2006-01-04 Impact factor: 56.272
Authors: Robert W Neumar; Jerry P Nolan; Christophe Adrie; Mayuki Aibiki; Robert A Berg; Bernd W Böttiger; Clifton Callaway; Robert S B Clark; Romergryko G Geocadin; Edward C Jauch; Karl B Kern; Ivan Laurent; W T Longstreth; Raina M Merchant; Peter Morley; Laurie J Morrison; Vinay Nadkarni; Mary Ann Peberdy; Emanuel P Rivers; Antonio Rodriguez-Nunez; Frank W Sellke; Christian Spaulding; Kjetil Sunde; Terry Vanden Hoek Journal: Circulation Date: 2008-10-23 Impact factor: 29.690
Authors: Nicholas Huynh; John Kloke; Chen Gu; Clifton W Callaway; Francis X Guyette; Kory Gebhardt; Rene Alvarez; Samuel A Tisherman; Jon C Rittenberger Journal: Resuscitation Date: 2012-06-26 Impact factor: 5.262
Authors: Eelco F M Wijdicks; William R Bamlet; Boby V Maramattom; Edward M Manno; Robyn L McClelland Journal: Ann Neurol Date: 2005-10 Impact factor: 10.422
Authors: Jon C Rittenberger; Francis X Guyette; Samuel A Tisherman; Michael A DeVita; Rene J Alvarez; Clifton W Callaway Journal: Resuscitation Date: 2008-11 Impact factor: 5.262
Authors: Patrick J Coppler; Jonathan Elmer; Jon C Rittenberger; Clifton W Callaway; David J Wallace Journal: Resuscitation Date: 2018-04-26 Impact factor: 5.262
Authors: Thomas Uray; Florian B Mayr; James Fitzgibbon; Jon C Rittenberger; Clifton W Callaway; Tomas Drabek; Anthony Fabio; Derek C Angus; Patrick M Kochanek; Cameron Dezfulian Journal: Resuscitation Date: 2015-05-21 Impact factor: 5.262
Authors: Patrick J Coppler; Keith A Marill; David O Okonkwo; Lori A Shutter; Cameron Dezfulian; Jon C Rittenberger; Clifton W Callaway; Jonathan Elmer Journal: Ther Hypothermia Temp Manag Date: 2016-06-01 Impact factor: 1.286
Authors: Patrick J Coppler; Jon C Rittenberger; David J Wallace; Clifton W Callaway; Jonathan Elmer Journal: Resuscitation Date: 2015-10-21 Impact factor: 5.262
Authors: Patrick J Coppler; Kelly N Sawyer; Chun Song Youn; Seung Pill Choi; Kyu Nam Park; Young-Min Kim; Joshua C Reynolds; David F Gaieski; Byung Kook Lee; Joo Suk Oh; Won Young Kim; Hyung Jun Moon; Benjamin S Abella; Jonathan Elmer; Clifton W Callaway; Jon C Rittenberger Journal: Ther Hypothermia Temp Manag Date: 2016-07-15 Impact factor: 1.286