Prediction in Neurological Outcomes in Cardiac Arrest Patients Before Inducing Targeted Temperature Management: Validation of CAST or cCAST

  • Mitsuaki Nishikimi


Not only a patient’s family but also ICU physicians need information on the probability of a patient recovering from post-cardiac arrest syndrome (PCAS) before admitting to the intensive care unit (ICU) and initiating targeted temperature management (TTM). In this section, we introduced a novel prediction tool for evaluating the neurological prognosis in patients with PCAS before TTM, called a post-Cardiac Arrest Syndrome for Therapeutic hypothermia score (CAST) and condensed CAST (cCAST). They have been developed using retrospective analyses from data of 151 consecutive adult patients who were admitted to four hospitals within the last 5 years to undergo TTM after cardiac arrest. While the CAST was calculated by using eight factors and logistic regression formula, the cCAST was modified by, though using same factors, more simple formula. The cCAST of 3.5 or lower was associated with a 0.99 (95% CI, 0.94–1.00) sensitivity and a 0.73 (0.61–0.84) specificity predicting for a poor outcome and 6.5 or higher was with a 0.80 (0.71–0.88) and a 0.97 (0.89–1.00). The “cCAST” can be calculated more easily and is useful for estimating the prognosis of PCAS patients, describing patients’ conditions to their family and making the decision before the initiation of TTM, as with the original CAST.


Post-cardiac arrest syndrome Neurological prognosis Targeted temperature management CAST cCAST 


95% CI

95% confidence interval


Post-cardiac arrest syndrome for therapeutic hypothermia score


condensed CAST


Cerebral performance categories


Emergency department


Glasgow Coma Scale


Gray matter attenuation to white matter attenuation ratio


Intensive care unit


Post-cardiac arrest syndrome


Targeted temperature management


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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Mitsuaki Nishikimi
    • 1
  1. 1.Department of Emergency and Critical CareNagoya University Graduate School of MedicineNagoyaJapan

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