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Predicting Outcomes of In-Hospital Cardiac Arrest: Retrospective US Validation of the Good Outcome Following Attempted Resuscitation Score

  • Jeffrey B. RubinsEmail author
  • Spencer D. Kinzie
  • David M. Rubins
Original Research

Abstract

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 in-hospital 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.

KEY WORDS

in-hospital cardiac arrest GO-FAR code status 

Notes

Acknowledgments

The authors thank Dr. Drew Rosielle and Dr. Rebecca Sternschein for their thoughtful reviews of this manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Jeffrey B. Rubins
    • 1
    Email author
  • Spencer D. Kinzie
    • 2
  • David M. Rubins
    • 3
  1. 1.Palliative Care Division, Hennepin Healthcare University of MinnesotaMinneapolisUSA
  2. 2.Division of General Internal Medicine, Hennepin Healthcare University of MinnesotaMinneapolisUSA
  3. 3.Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

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