Neurology in critical care · Prognostication after cardiac arrest
Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival
| Design | Cohort study with external validation |
|---|---|
| Treatment | Three objective criteria applied at hospital arrival |
| Control | None — diagnostic accuracy study |
| Population | 772 patients with out-of-hospital cardiac arrest meeting the objective criteria in the Paris cohort |
| Follow-up | Survival to hospital discharge |
| Primary endpoint | Survival among patients meeting all three criteria |
| Result | Survival among the 772 patients meeting the objective criteria was 0% (95% CI 0.0% to 0.5%), with specificity 100% (95% CI 97% to 100%). |
| Secondary endpoints | Positive predictive value, applicability to organ donation pathways |
Three objective criteria enable the early identification of patients with OHCA with essentially no chance of survival and may help in decision making about the organ donation process.
The trial authors, in the published abstract
Rules of this kind are only as good as their specificity, and 100% with a tight confidence interval is about as good as prognostic criteria get. The intended use — informing organ donation conversations rather than withdrawing treatment — is a distinction worth preserving in practice.
Jabre P, Bougouin W, Dumas F, et al. Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation. Ann Intern Med 2016 Dec 6;165(11):770-778.