Prediction of the neurological outcomes post-cardiac arrest: A prospective validation of the CAST and rCAST

• Published in: The American journal of emergency medicine 2024-01, Vol.75, p.46-52
• Main Authors: Kikutani, Kazuya, Nishikimi, Mitsuaki, Matsui, Kota, Sakurai, Atsushi, Hayashida, Kei, Kitamura, Nobuya, Tagami, Takashi, Nakada, Takaaki, Matsui, Shigeyuki, Ohshimo, Shinichiro, Shime, Nobuaki
• Format: Article
• Language: English
• Subjects: Accuracy; Angioplasty; Area Under Curve; Blood tests; Body temperature; Brain Injuries; Brain injury; Cardiac arrest; Cardiopulmonary resuscitation; Comorbidity; CPR; Dementia; Emergency medical care; Emergency services; Extracorporeal membrane oxygenation; Gray Matter; Heart; Hospitals; Humans; Hypothermia; Medical imaging; Medical prognosis; Observational studies; Out-of-Hospital Cardiac Arrest - therapy; Patients; Post-cardiac arrest syndrome; Prognosis; Substantia alba; Targeted temperature management; Therapeutic hypothermia
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2023.10.028

The neurologic prognosis of out-of-hospital cardiac arrest (OHCA) patients in whom return of spontaneous circulation (ROSC) is achieved remains poor. The aim of this study was to externally and prospectively validate two scoring systems developed by us: the CAST score, a scoring system to predict the neurological prognosis of OHCA patients undergoing targeted temperature management (TTM), and a simplified version of the same score developed for improved ease of use in clinical settings, the revised CAST (rCAST) score. This study was a prospective, multicenter, observational study conducted using the SOS KANTO 2017 registry, an OHCA registry involving hospitals in the Kanto region (including Tokyo) of Japan. The primary outcome was favorable neurological outcome (defined as Cerebral Performance Category score of 1 or 2) at 30 days and the secondary outcomes were favorable neurological outcome at 90 days and survival at 30 and 90 days. The predictive accuracies of the original CAST (oCAST) and rCAST scores were evaluated by using area under the receiver operating characteristic curve (AUC). Of 9909 OHCA patients, 565 showed ROSC and received TTM. Of these, we analyzed the data of 259 patients in this study. The areas under the receiver operating characteristic curve (AUCs) of the oCAST and rCAST scores for predicting a favorable neurological outcome at 30 days were 0.86 and 0.87, respectively, and those for predicting a favorable neurological outcome at 90 days were 0.87 and 0.88, respectively. The rCAST showed a higher predictive accuracy for the neurological outcome as compared with the NULL-PLEASE score. The patients with a favorable neurological outcome who had been classified into the high severity group based on the rCAST tended to have hypothermia at hospital arrival and to not show any signs of loss of gray-white matter differentiation on brain CT. Neurological function at 90 days was correlated with the rCAST (r = 0.63, p