A novel scoring system for predicting the neurologic prognosis prior to the initiation of induced hypothermia in cases of post-cardiac arrest syndrome: the CAST scoreReport as inadecuate

A novel scoring system for predicting the neurologic prognosis prior to the initiation of induced hypothermia in cases of post-cardiac arrest syndrome: the CAST score - Download this document for free, or read online. Document in PDF available to download.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

, 25:49

First Online: 10 May 2017Received: 12 February 2017Accepted: 04 May 2017DOI: 10.1186-s13049-017-0392-y

Cite this article as: Nishikimi, M., Matsuda, N., Matsui, K. et al. Scand J Trauma Resusc Emerg Med 2017 25: 49. doi:10.1186-s13049-017-0392-y


BackgroundThe aim of this study was to develop a scoring system for identifying the post-cardiac arrest syndrome PCAS patients with a good potential for recovery prior to the initiation of induced therapeutic hypothermia.

MethodsA multi-center, retrospective, observational study was performed. Data of a total of 151 consecutive adults who underwent induced hypothermia after cardiac arrest 77 learning cases from two hospitals and 74 validation cases from two other hospitals were analyzed.

ResultsIn the learning set, 8 factors initial rhythm, witnessed status and time until return of spontaneous circulation, pH, serum lactate, motor score according to the Glasgow Coma Scale GCS, gray matter attenuation to white matter attenuation ratio GWR, serum albumin, and hemoglobin were found to be strongly correlated with the neurological outcomes. A tentative scoring system was created from the learning data using these factors, and the predictive accuracy sensitivity and specificity was evaluated in terms of both internal validation 0.85 and 0.84 and external validation cutoff 50%: 0.95 and 0.90, 30%: 0.87 and 0.98, 15%: 0.67 and 1.00. Finally, using all the data, we established a post-Cardiac Arrest Syndrome for induced Therapeutic hypothermia CAST score to predict the neurologic prognosis prior to initiation of induced hypothermia.

ConclusionsThe CAST score was developed to predict the neurological outcomes of PCAS patients treated by induced hypothermia. The likelihood of good recovery at 30 days was extremely low in PCAS patients with a CAST score of ≤15%. Prospective validation of the score is needed in the future.

KeywordsPost-cardiac arrest syndrome Neurological prognosis Induced hypothermia CAST score AbbreviationsPCASPost-cardiac arrest syndrome

GCSGlasgow coma scale

GWRGray matter attenuation to white matter attenuation ratio

CAST scorePost-cardiac arrest syndrome for induced therapeutic hypothermia score

ROSCReturn of spontaneous circulation

ICUIntensive care unit

CRPC-reactive protein



CPCCerebral performance categories

PCCProportion of correct classification

95% CI95% confidence interval

ROCReceiver operator characteristic

AUCArea under the curve

NagoyaNagoya University Hospital

ChutouenChutouen General Medical Center

KomakiKomaki City General Hospital

MaebashiJapan Red Cross Maebashi Hospital

rCorrelation ratio

LogisticLogistic regression algorithm

Dec. treeDecision tree algorithm



Electronic supplementary materialThe online version of this article doi:10.1186-s13049-017-0392-y contains supplementary material, which is available to authorized users.

Author: Mitsuaki Nishikimi - Naoyuki Matsuda - Kota Matsui - Kunihiko Takahashi - Tadashi Ejima - Keibun Liu - Takayuki Ogura - Mic

Source: https://link.springer.com/

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