Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: An external validation of the HOPE score

RESUSCITATION

卷:139

Article

Pasquier, Mathieu¹  Rousson, Valentin²  Darocha, Tomasz³  Bouzat, Pierre⁴  Kosinski, Sylweriusz⁵  Sawamoto, Keigo⁶  Champigneulle, Benoit⁷  Wiberg, Sebastian⁸  Wanscher, Michael C. Jaeger⁹  Maeder, Monika Brodmann¹⁰  Paal, Peter¹¹  Hugli, Olivier¹ 

[1] Lausanne Univ Hosp, Emergency Dept, Lausanne, Switzerland

[2] Lausanne Univ Hosp, Inst Social & Prevent Med, Route Corniche 10, CH-1010 Lausanne, Switzerland

[3] Med Univ Silesia, Dept Anaesthesiol & Intens Care, Severe Accidental Hypothermia Ctr, Poniatowskiego 15, PL-055 Katowice, Poland

[4] Univ Hosp Grenoble, French Mt Rescue Assoc ANMSM, Int Commiss Mt Emergency Med ICAR MEDCOM, Dept Anesthesiol & Crit Care,Grenoble Alps Trauma, F-38043 Grenoble 09, France

[5] Jagiellonian Univ, Fac Hlth Sci, Severe Accidental Hypothermia Ctr, Krakow, Poland

[6] Sapporo Med Univ, Dept Emergency Med, Chuo Ku, S1W16, Sapporo, Hokkaido 0608543, Japan

[7] Georges Pompidou European Hosp, AP HP, Surg Intens Care Unit, Paris, France

[8] Rigshosp, Copenhagen Univ Hosp, Ctr Heart, Dept Cardiol, Copenhagen, Denmark

[9] Copenhagen Univ Hosp, Dept Cardiothorac Anaesthesia, Heart Ctr 4142, Copenhagen, Denmark

[10] Inselspital Bern, Univ Notfallzentrum, CH-3010 Bern, Switzerland

[11] Paracelsus Med Univ, Hosp Bros Hosp, Dept Anesthesiol & Intens Care Med, A-5020 Salzburg, Austria

关键词: Cardiac arrest;    ECMO;    ECPR;    Hypothermia;    Accidental;    Potassium;    Resuscitation;    Triage;   

DOI  :  10.1016/j.resuscitation.2019.03.017

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

Free