Predicting survival in patients admitted to intensive care following out-of-hospital cardiac arrest using the Prognosis After Resuscitation score

Introduction

Out-of-hospital cardiac arrest (OHCA) has a poor prognosis even after successful resuscitation [1]. No scoring system has been fully validated for predicting survival following OHCA. The Prognosis After Resuscitation (PAR) score was developed from metaanalysis in 1992. A score >5 (from seven variables) predicts nonsurvival following in-hospital cardiac arrest (IHCA) [2, 3]. Porter and colleagues demonstrated that PAR >5 is a useful predictor of nonsurvival for combined IHCA/OHCA ICU admissions [4]. We aim to evaluate PAR application to adult ICU admissions at University Hospitals Bristol (UHB), UK following OHCA.

Methods

The Innovian (Dräger) electronic clinical information database was searched retrospectively for all OHCA ICU admissions from 2010 to 2012. Data were extracted using an electronic pro forma in Microsoft Excel. Missing/incomplete data were excluded. Survival was defined as survival to discharge from the acute hospital (UHB).

Results

There were 247 admissions to the ICU following OHCA from 2010 to 2012. Seven patients were excluded for missing/incomplete data. In total, 102 patients (42.5%) survived to discharge. PAR ranged from -2 to 18. Zero was the most frequent score. Only one of 15 admissions with PAR >5 (PAR 13) survived. A total of 101 patients with PAR ≤5 survived (45%). Acute myocardial infarction was identified as the precipitating event in 111 patients (46%).

Conclusion

Only one of 240 OHCA patients admitted to the ICU over a 3-year period with PAR >5 survived until discharge. PAR scoring has been shown to be useful in helping decide the appropriateness of ICU admission for combined IHCA/OHCA. Our data support its use in isolated OHCA. PAR ≤5 appears to be poorly predictive of survival. However, PAR >5, combined with clinical evaluation, could help identify OHCA nonsurvivors and avoid ICU admissions that do not benefit the patient.