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Derivation and vali...
Derivation and validation of the CREST model for very early prediction of circulatory etiology death in patients without ST-segment-elevation myocardial infarction after cardiac arrest
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- Bascom, Karen E. (author)
- Maine Medical Center
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- Dziodzio, John (author)
- Maine Medical Center
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- Vasaiwala, Samip (author)
- Maine Medical Center
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- Mooney, Michael (author)
- Abbott Northwestern Hospital
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- Patel, Nainesh (author)
- Lehigh Valley Hospital
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- McPherson, John (author)
- Vanderbilt University
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- McMullan, Paul (author)
- Baptist Hospital, Nashville
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- Unger, Barbara (author)
- Minneapolis Heart Institute
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- Nielsen, Niklas (author)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Kliniska Vetenskaper, Helsingborg,Institutionen för kliniska vetenskaper, Lund,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,LUBIN Lab- Lunds laboratorium för neurokirurgisk hjärnskadeforskning,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Clinical Sciences, Helsingborg,Department of Clinical Sciences, Lund,Center for cardiac arrest,Lund University Research Groups,LUBIN Lab- Lund Brain Injury laboratory for Neurosurgical research,Helsingborg Hospital
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- Friberg, Hans (author)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,SWECRIT,LUBIN Lab- Lunds laboratorium för neurokirurgisk hjärnskadeforskning,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Center for cardiac arrest,Lund University Research Groups,LUBIN Lab- Lund Brain Injury laboratory for Neurosurgical research,Skåne University Hospital
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- Riker, Richard R. (author)
- Maine Medical Center
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- Kern, Karl B. (author)
- University of Arizona
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- Duarte, Christine W. (author)
- Maine Medical Center Research Institute
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- Seder, David B. (author)
- Maine Medical Center
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(creator_code:org_t)
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- 2018
- 2018
- English.
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In: Circulation. - 0009-7322. ; 137:3, s. 273-282
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http://dx.doi.org/10...
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Abstract
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- BACKGROUND: No practical tool quantitates the risk of circulatory-etiology death (CED) immediately after successful cardiopulmonary resuscitation in patients without ST-segment-elevation myocardial infarction. We developed and validated a prediction model to rapidly determine that risk and facilitate triage to individualized treatment pathways. METHODS: With the use of INTCAR (International Cardiac Arrest Registry), an 87-question data set representing 44 centers in the United States and Europe, patients were classified as having had CED or a combined end point of neurological-etiology death or survival. Demographics and clinical factors were modeled in a derivation cohort, and backward stepwise logistic regression was used to identify factors independently associated with CED. We demonstrated model performance using area under the curve and the Hosmer-Lemeshow test in the derivation and validation cohorts, and assigned a simplified point-scoring system. RESULTS: Among 638 patients in the derivation cohort, 121 (18.9%) had CED. The final model included preexisting coronary artery disease (odds ratio [OR], 2.86; confidence interval [CI], 1.83-4.49; P≤0.001), nonshockable rhythm (OR, 1.75; CI, 1.10-2.77; P=0.017), initial ejection fraction<30% (OR, 2.11; CI, 1.32-3.37; P=0.002), shock at presentation (OR, 2.27; CI, 1.42-3.62; P<0.001), and ischemic time >25 minutes (OR, 1.42; CI, 0.90-2.23; P=0.13). The derivation model area under the curve was 0.73, and Hosmer-Lemeshow test P=0.47. Outcomes were similar in the 318-patient validation cohort (area under the curve 0.68, Hosmer-Lemeshow test P=0.41). When assigned a point for each associated factor in the derivation model, the average predicted versus observed probability of CED with a CREST score (coronary artery disease, initial heart rhythm, low ejection fraction, shock at the time of admission, and ischemic time >25 minutes) of 0 to 5 was: 7.1% versus 10.2%, 9.5% versus 11%, 22.5% versus 19.6%, 32.4% versus 29.6%, 38.5% versus 30%, and 55.7% versus 50%. CONCLUSIONS: The CREST model stratified patients immediately after resuscitation according to risk of a circulatory-etiology death. The tool may allow for estimation of circulatory risk and improve the triage of survivors of cardiac arrest without ST-segment-elevation myocardial infarction at the point of care.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Cardiomyopathies
- Cardiopulmonary resuscitation
- Forecasting
- Heart arrest
- Prognosis
- Shock
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Bascom, Karen E.
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Dziodzio, John
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Vasaiwala, Samip
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Mooney, Michael
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Patel, Nainesh
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McPherson, John
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show more...
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McMullan, Paul
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Unger, Barbara
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Nielsen, Niklas
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Friberg, Hans
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Riker, Richard R ...
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Kern, Karl B.
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Duarte, Christin ...
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Seder, David B.
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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Circulation
- By the university
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Lund University