Derivation and validation of the CREST model for very early prediction of circulatory etiology death in patients without ST-segment-elevation myocardial infarction after cardiac arrest.
Critical Care, MMCRI
BACKGROUND: No practical tool quantitates the risk of circulatory-etiology death (CED) immediately after successful cardiopulmonary resuscitation in patients without ST-segment-elevation myocardial infarction. We developed and validated a prediction model to rapidly determine that risk and facilitate triage to individualized treatment pathways.
METHODS: With the use of INTCAR (International Cardiac Arrest Registry), an 87-question data set representing 44 centers in the United States and Europe, patients were classified as having had CED or a combined end point of neurological-etiology death or survival. Demographics and clinical factors were modeled in a derivation cohort, and backward stepwise logistic regression was used to identify factors independently associated with CED. We demonstrated model performance using area under the curve and the Hosmer-Lemeshow test in the derivation and validation cohorts, and assigned a simplified point-scoring system.
RESULTS: Among 638 patients in the derivation cohort, 121 (18.9%) had CED. The final model included preexisting coronary artery disease (odds ratio [OR], 2.86; confidence interval [CI], 1.83-4.49;
CONCLUSIONS: The CREST model stratified patients immediately after resuscitation according to risk of a circulatory-etiology death. The tool may allow for estimation of circulatory risk and improve the triage of survivors of cardiac arrest without ST-segment-elevation myocardial infarction at the point of care.
Bascom, Karen E; Dziodzio, John; Vasaiwala, Samip; Mooney, Michael; Patel, Nainesh; McPherson, John; McMullan, Paul; Unger, Barbara; Nielsen, Niklas; Friberg, Hans; Riker, Richard R; Kern, Karl B; Duarte, Christine W; and Seder, David B, "Derivation and validation of the CREST model for very early prediction of circulatory etiology death in patients without ST-segment-elevation myocardial infarction after cardiac arrest." (2018). Maine Medical Center. 485.