Background: Patients sustaining return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) with ST elevation myocardial infarction (STEMI) by ECG have often been lumped into the same treatment as patients without OHCA. This scenario holds an extremely high mortality rate and many patients do not survive regardless of intervention. We sought to develop a scoring system (Thoughtful Pause) that can identify patients who are unlikely to benefit from emergent percutaneous coronary intervention (PCI).
Methods: We constructed a patient scoring system, the Thoughtful Pause, to predict survival with favorable neurological outcomes at discharge and 6 months using Cerebral Performance Category (CPC) 1 or 2. The Thoughtful Pause tool assigns one point for each specific criteria met including unwitnessed arrest, no bystander CPR, CPR > 20 minutes, age > 80, pH < 7.2, GCS = 3, active bleeding, and advanced dementia. Each patient was then given a Thoughtful Pause score that was applied to one of three categories: green (scores 0-1), yellow (scores 2-3), or red (scores >3). Our tool was applied retrospectively to all patients with OHCA with initial shockable rhythm with STEMI from 2013-2017 at a tertiary care center. All patients had STEMI by ECG based on the third universal definition. The cardiac catheterization lab was activated for all patients. Statistical analysis was achieved using a Wilcoxon-Mann Whitney test. The Institution Review Board at the Medical College of Wisconsin approved this study
Results: Twenty-six patients were identified to fit the criteria and were included in the study. All patients with a Thoughtful Pause score >3 expired (12 patients) (P=0.004). All patients with a Thoughtful Pause score 0-1 survived (4 patients). Variations in survival existed with Thoughtful Pause scores 2-3 (10 patients with 40% survival). Of the surviving patients, all had favorable neurological outcome (CPC 1 or 2) except one patient (Thoughtful Pause score 2). CPC scores did not change at discharge vs 6 months.
Conclusion: The Thoughtful Pause shows ability to predict benefit from emergent catheterization in OHCA with STEMI and survival to hospital discharge.