Vol 28, No 1 (2021)
Original Article
Published online: 2019-04-11

open access

Page views 2001
Article views/downloads 1613
Get Citation

Connect on Social Media

Connect on Social Media

Predicting survival in out-of-hospital cardiac arrest patients undergoing targeted temperature management: The Polish Hypothermia Registry Risk Score

Łukasz Kołtowski1, Beata Średniawa2, Agnieszka Tycińska3, Magdalena Czajkowska4, Magdalena Niedziela15, Wiesław Puchalski6, Ewa Szczerba1, Robert Kowalik1, Robert Ryczek7, Barbara Zawiślak8, Elżbieta Kremis9, Konrad Koza10, Agnieszka Nazaruk11, Joanna Wolska12, Michał Ordak13, Grzegorz Opolski1, Janina Stępińska9
Pubmed: 30994183
Cardiol J 2021;28(1):95-100.


Background: Prompt reperfusion and post-resuscitation care, including targeted temperature management
(TTM), improve survival in out-of-hospital cardiac arrest (OHCA) patients. To predict inhospital mortality in OHCA patients treated with TTM, the Polish Hypothermia Registry Risk Score (PHR-RS) was developed. The use of dedicated risk stratification tools may support treatment decisions.

Methods: Three hundred seventy-six OHCA patients who underwent TTM between 2012 and 2016 were retrospectively analysed and whose data were collected in the Polish Hypothermia Registry. A multivariate
logistic regression model identified a set of predictors of in-hospital mortality that were used to develop a dedicated risk prediction model, which was tested for accuracy.

Results: The mean age of the studied population was 59.2 ± 12.9 years. 80% of patients were male, 73.8% had shockable rhythms, and mean time from cardiac arrest (CA) to cardiopulmonary resuscitation (CPR) was 7.2 ± 8.6 min. The inputs for PHR-RS were patient age and score according to the Mild Therapeutic Hypothermia (MTH) Scale. Criteria for the MTH score consisted of time from CA to CPR above 10 min, time from CA to the return of spontaneous circulation above 20 min, in-hospital CA, unwitnessed CA, and non-shockable rhythm, each counted as 1 point. The predictive value of PHR-RS was expressed as an area under the curve of 0.74.

Conclusions: PHR-RS is one of the simplest and easiest models to use and enables a reliable prediction of in-hospital mortality in OHCA patients treated with TTM.

Article available in PDF format

View PDF Download PDF file


  1. Lick CJ, Aufderheide TP, Niskanen RA, et al. Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest. Crit Care Med. 2011; 39(1): 26–33.
  2. Ishikawa S, Niwano S, Imaki R, et al. Usefulness of a simple prognostication score in prediction of the prognoses of patients with out-of-hospital cardiac arrests. Int Heart J. 2013; 54(6): 362–370.
  3. Skrifvars MB, Varghese B, Parr MJ. Survival and outcome prediction using the Apache III and the out-of-hospital cardiac arrest (OHCA) score in patients treated in the intensive care unit (ICU) following out-of-hospital, in-hospital or ICU cardiac arrest. Resuscitation. 2012; 83(6): 728–733.
  4. Sasson C, Rogers MAM, Dahl J, et al. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010; 3(1): 63–81.
  5. Adielsson A, Hollenberg J, Karlsson T, et al. Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective. Heart. 2011; 97(17): 1391–1396.
  6. Wibrandt I, Norsted K, Schmidt H, et al. Predictors for outcome among cardiac arrest patients: the importance of initial cardiac arrest rhythm versus time to return of spontaneous circulation, a retrospective cohort study. BMC Emerg Med. 2015; 15: 3.
  7. Iqbal MB, Al-Hussaini A, Rosser G, et al. Predictors of survival and favorable functional outcomes after an out-of-hospital cardiac arrest in patients systematically brought to a dedicated heart attack center (from the Harefield Cardiac Arrest Study). Am J Cardiol. 2015; 115(6): 730–737.
  8. Whittaker A, Lehal M, Calver AL, et al. Predictors of inhospital mortality following out-of-hospital cardiac arrest: Insights from a single-centre consecutive case series. Postgrad Med J. 2016; 92(1087): 250–254.
  9. Gach D, Nowak JU, Krzych ŁJ. Determinants of unfavorable prognosis for out-of-hospital sudden cardiac arrest in Bielsko-Biala district. Kardiochir Torakochirurgia Pol. 2016; 13(3): 217–223.
  10. Aldhoon B, Melenovsky V, Kettner J, et al. Clinical predictors of outcome in survivors of out-of-hospital cardiac arrest treated with hypothermia. Cor et Vasa. 2012; 54(2): e68–e75.
  11. Bougouin W, Mustafic H, Marijon E, et al. Gender and survival after sudden cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2015; 94: 55–60.
  12. Bosson N, Kaji AH, Fang A, et al. Sex differences in survival from out-of-hospital cardiac arrest in the era of regionalized systems and advanced post-resuscitation care. J Am Heart Assoc. 2016; 5(9).
  13. Pachys G, Kaufman N, Bdolah-Abram T, et al. Predictors of long-term survival after out-of-hospital cardiac arrest: the impact of Activities of Daily Living and Cerebral Performance Category scores. Resuscitation. 2014; 85(8): 1052–1058.
  14. Winther-Jensen M, Kjaergaard J, Wanscher M, et al. No difference in mortality between men and women after out-of-hospital cardiac arrest. Resuscitation. 2015; 96: 78–84.
  15. Fabbri A, Marchesini G, Spada M, et al. Monitoring intervention programmes for out-of-hospital cardiac arrest in a mixed urban and rural setting. Resuscitation. 2006; 71(2): 180–187.
  16. Adnet F, Triba MN, Borron SW, et al. Cardiopulmonary resuscitation duration and survival in out-of-hospital cardiac arrest patients. Resuscitation. 2017; 111: 74–81.
  17. Krawczyk P, Tarczyńska A, Dziadek G, et al. Implementation of targeted temperature management after cardiac arrest in Polish intensive care units. What has changed in the last five years? Kardiol Pol. 2017; 75(7): 689–697.
  18. Storm C, Nee J, Sunde K, et al. A survey on general and temperature management of post cardiac arrest patients in large teaching and university hospitals in 14 European countries-The SPAME trial results. Resuscitation. 2017; 116: 84–90.