Mathieu Pasquier1, Valentin Rousson2, Tomasz Darocha3, Pierre Bouzat4, Sylweriusz Kosiński5, Keigo Sawamoto6, Benoit Champigneulle7, Sebastian Wiberg8, Michael C Jaeger Wanscher9, Monika Brodmann Maeder10, Peter Paal11, Olivier Hugli12. 1. Emergency Department, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: Mathieu.Pasquier@chuv.ch. 2. Institute of Social and Preventive Medicine, Lausanne University Hospital, route de la Corniche 10, 1010 Lausanne, Switzerland. Electronic address: valentin.rousson@chuv.ch. 3. Severe Accidental Hypothermia Center, Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Poniatowskiego 15, 055 Katowice, Poland. Electronic address: tomekdarocha@wp.pl. 4. Department of anesthesiology and critical care, Grenoble Alps Trauma Center, University Hospital of Grenoble, French Mountain Rescue Association ANMSM, International Commission for Mountain Emergency Medicine ICAR MEDCOM, 38043 Grenoble Cedex 09, France. Electronic address: PBouzat@chu-grenoble.fr. 5. Severe Accidental Hypothermia Center, Cracow, Faculty of Health Sciences, Jagiellonian University, Cracow, Poland. Electronic address: kosa@mp.pl. 6. Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuoku Sapporo, 060-8543 Hokkaido, Japan. Electronic address: keigosapmed@yahoo.co.jp. 7. Surgical Intensive Care Unit, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: benoit.champigneulle@aphp.fr. 8. Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark. Electronic address: scwiberg@gmail.com. 9. Dept. of Cardiothoracic Anaesthesia, 4142 The Heart Center, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: michael.jaeger.wanscher@regionh.dk. 10. Universitäres Notfallzentrum, Inselspital, 3010 Bern, Switzerland. Electronic address: monika.brodmann@insel.ch. 11. Department of Anesthesiology and Intensive Care Medicine, Hospitaller Brothers Hospital, Paracelsus Medical University, 5020 Salzburg, Austria. Electronic address: peter.paal@icloud.com. 12. Emergency Department, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: olivier.hugli@chuv.ch.
Abstract
AIMS: The HOPE score, based on covariates available at hospital admission, predicts the probability of in-hospital survival after extracorporeal life support (ECLS) rewarming of a given hypothermic cardiac arrest patient with accidental hypothermia. Our goal was to externally validate the HOPE score. METHODS: We included consecutive hypothermic arrested patients who underwent rewarming with ECLS. The sample comprised 122 patients. The six independent predictors of survival included in the HOPE score were collected for each patient: age, sex, mechanism of hypothermia, core temperature at admission, serum potassium level at admission and duration of CPR. The primary outcome parameter was survival to hospital discharge. RESULTS: Overall, 51 of the 122 included patients survived, resulting in an empirical (global) probability of survival of 42% (95% CI = [33-51%]). This was close to the average HOPE survival probability of 38% calculated for patients from the validation cohort, while the Hosmer-Lemeshow test comparing empirical and HOPE (i.e. estimated) probabilities of survival was not significant (p = 0.08), suggesting good calibration. The corresponding area under the receiver operating characteristic curve was 0.825 (95% CI = [0.753-0.897]), confirming the excellent discrimination of the model. The negative predictive value of a HOPE score cut-off of <0.10 was excellent (97%). CONCLUSIONS: This study provides the first external validation of the HOPE score reaching good calibration and excellent discrimination. Clinically, the prediction of the HOPE score remains accurate in the validation sample. The HOPE score may replace serum potassium in the future as the triage tool when considering ECLS rewarming of a hypothermic cardiac arrest victim.
AIMS: The HOPE score, based on covariates available at hospital admission, predicts the probability of in-hospital survival after extracorporeal life support (ECLS) rewarming of a given hypothermic cardiac arrestpatient with accidental hypothermia. Our goal was to externally validate the HOPE score. METHODS: We included consecutive hypothermic arrestedpatients who underwent rewarming with ECLS. The sample comprised 122 patients. The six independent predictors of survival included in the HOPE score were collected for each patient: age, sex, mechanism of hypothermia, core temperature at admission, serum potassium level at admission and duration of CPR. The primary outcome parameter was survival to hospital discharge. RESULTS: Overall, 51 of the 122 included patients survived, resulting in an empirical (global) probability of survival of 42% (95% CI = [33-51%]). This was close to the average HOPE survival probability of 38% calculated for patients from the validation cohort, while the Hosmer-Lemeshow test comparing empirical and HOPE (i.e. estimated) probabilities of survival was not significant (p = 0.08), suggesting good calibration. The corresponding area under the receiver operating characteristic curve was 0.825 (95% CI = [0.753-0.897]), confirming the excellent discrimination of the model. The negative predictive value of a HOPE score cut-off of <0.10 was excellent (97%). CONCLUSIONS: This study provides the first external validation of the HOPE score reaching good calibration and excellent discrimination. Clinically, the prediction of the HOPE score remains accurate in the validation sample. The HOPE score may replace serum potassium in the future as the triage tool when considering ECLS rewarming of a hypothermic cardiac arrest victim.
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