title: Prediction protocol for neurological outcome for survivors of out-of-hospital cardiac arrest treated with targeted temperature management.
abstract: OBJECTIVE
  To identify patients who can obtain the full benefit from targeted temperature management (TTM) after out-of-hospital cardiac arrest.
  
  
  METHODS
  We performed a retrospective observational study of comatose patients treated with TTM after an out-of-hospital cardiac arrest from January 2006 to February 2011. Neurological outcome was evaluated with the Glasgow-Pittsburgh Cerebral Performance category (CPC) at discharge and predictors were determined.
  
  
  RESULTS
  Of 66 patients studied, 40 (60.6%) survived to neurologically intact discharge (CPC 1 or 2). According to multivariate analysis, predictors of good neurological outcome included arrest-to-first cardiopulmonary resuscitation attempt interval ≤5 min, ventricular fibrillation or ventricular tachycardia in the first monitored rhythm, absence of re-arrest before leaving the emergency department, arrest-to-return of spontaneous circulation interval ≤30 min and recovery of pupillary light reflex, which were identifiable in the emergency department. Based on this analysis, we developed a seven-point score (5-R score). If the score was ≥5, it predicted good neurological outcome with a sensitivity of 82.5% (95% confidence interval [CI], 67.2-92.7%) and specificity of 92.3% (95% CI, 74.9-99.1%). The negative predictive value of a score ≥4 was 100% (95% CI, 81.5-100%). Our prediction model was validated internally by a bootstrapping technique.
  
  
  CONCLUSIONS
  The prediction protocol using the 5-R score was associated with good neurological outcome of patients treated with TTM. Therefore, it could be helpful in clinical decision making on whether to initiate cooling.
authors.affiliation: Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan. okaka.jp@gmail.com
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Okada
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ohde
authors.forename: Norio
authors.initials: N
authors.lastname: Otani
authors.forename: Toshiki
authors.initials: T
authors.lastname: Sera
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Mochizuki
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Aoki
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ishimatsu
mesh_terms: D000368:Aged; D001927:Brain Diseases / Q000175:diagnosis / Q000209:etiology; D016887:Cardiopulmonary Resuscitation; D003128:Coma / Q000150:complications* / Q000175:diagnosis; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity