Predicting Outcomes of In-Hospital Cardiac Arrest: Retrospective US Validation of the Good Outcome Following Attempted R
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Palliative Care Division, Hennepin Healthcare , University of Minnesota, Minneapolis, MN, USA; 2Division of General Internal Medicine, Hennepin Healthcare , University of Minnesota, Minneapolis, MN, USA; 3Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.
BACKGROUND: Providers should estimate a patient’s chance of surviving an in-hospital cardiac arrest with good neurologic outcome when initially admitting a patient, in order to participate in shared decision making with patients about their code status. OBJECTIVE: To examine the utility of the “Good Outcome Following Attempted Resuscitation (GO-FAR)” score in predicting prognosis after in-hospital cardiac arrest in a US trauma center. DESIGN: Retrospective observational study SETTING: Level 1 trauma and academic hospital in Minneapolis, MN, USA PARTICIPANTS: All cases of pulseless in-hospital cardiac arrest occurring in adults (18 years or older) admitted to the hospital between Jan 2009 and Sept 2018 are included. For patients with more than one arrest, only the first was included in this analysis. MAIN MEASURES: For each patient with verified inhospital cardiac arrest, we calculated a GO-FAR score based on variables present in the electronic health record at time of admission. Pre-determined outcomes included survival to discharge and survival to discharge with good neurologic outcome. KEY RESULTS: From 2009 to 2018, 403 adults suffered in-hospital cardiac arrest. A majority (65.5%) were male with a mean age of 60.3 years. Overall survival to discharge was 33.0%; survival to discharge with good neurologic outcome was 17.4%. GO-FAR score calculated at the time of admission correlated with survival to discharge with good neurologic outcome (AUC 0.68), which occurred in 5.3% of patients with below average survival likelihood by GO-FAR score, 22.5% with average survival likelihood, and 34.1% with above average survival likelihood. CONCLUSIONS: The GO-FAR score can estimate, at time of admission to the hospital, the probability that a patient will survive to discharge with good neurologic outcome after an in-hospital cardiac arrest. This prognostic information can help providers frame discussions with patients on admission regarding whether to attempt cardiopulmonary resuscitation in the event of cardiac arrest. This paper has not been presented at any conference. Received December 17, 2018 Revised May 15, 2019 Accepted August 7, 2019
KEY WORDS: in-hospital cardiac arrest; GO-FAR; code status. J Gen Intern Med DOI: 10.1007/s11606-019-05314-x © Society of General Internal Medicine 2019
INTRODUCTION
In-hospital cardiac arrest (IHCA) affects an estimated 209,000 patients in the USA annually, with an overall rate of survival to discharge most recently estimated at 25.8%.1 Hospitals are required to elicit patient choices at time of hospital admission regarding end-of-life events, including choices about treatment for IHCA, in accordance with the Patient SelfDetermination Act of 1990.2 Discussions with patients about the bene
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