Modified Rankin score at hospital discharge is predictive of one-year neurologic function in survivors after cardiac arrest [abstract]
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Background. A randomized multicenter clinical trial compared standard cardiopulmonary resuscitation (S-CPR) with active compression–decompression CPR plus an inspiratory impedance threshold device (ACD+ITD) in patients with nontraumatic, out-of-hospital cardiac arrest (OHCA) from a presumed cardiac cause. Survival to hospital discharge (HD) with favorable neurologic function, defined as a modified Rankin score (MRS) ¡Â3, and one-year survival were greater in the ACD+ITD group. We evaluated the concordance of the primary end point, HD with MRS ¡Â3, with multiple secondary neurologic end points assessed at one year. Methods. A total of 813 patients were enrolled in the S-CPR group and 842 in the ACD+ITD group. The MRS at HD, and the Cerebral Performance Category Scale (CPC), Overall Performance Category (OPC), Health Utilities Index (HUI), and Cognitive Abilities Screening Instrument (CASI) assessments were based on responses from consented survivors and known deaths at one year. Neurologic assessments were administered by research staff blinded to the CPR treatment. Survival data were available for 98% of subjects. Fisher’s exact test, Pearson chi-square test, Mann-Whitney U test, and t-test for equality of means were used, as applicable, for comparisons. All statistical tests were two-sided, and p-values <0.05 were regarded as significant. Results. The MRS (¡Â3 vs. >3) neurologic assessment at HD was highly predictive of whether a patient would be alive with favorable neurologic function in both study groups, assessed using the CPC score (>3 vs. ¡Â3) at one year: 35 of 37 (94.6%) subjects in the S-CPR group and 50 of 54 (92.6%) subjects in the ACD+ITD group with MRS ¡Â3 at HD had CPC >3 at one year (98.0% observed agreement, kappa = 0.800, p < 0.001). Similar concordance was also shown with overall survival, OPC, HUI, and CASI. Conclusion. Neurologic status at the time of HD, as measured by MRS, is highly predictive of long-term neurologic function at one year. This is the first time that the MRS at the time of HD has demonstrated the ability to predict long-term outcomes for patients with OHCA.