Clinician miscalibration of survival estimate in hypothermic cardiac arrest: HOPE-estimated survival probabilities in extreme cases

Tomasz Darocha; Olivier Hugli; Sylweriusz Kosiński; Paweł Podsiadło; David Caillet-Bois; Mathieu Pasquier

doi:10.1016/j.resplu.2021.100139

Clinician miscalibration of survival estimate in hypothermic cardiac arrest: HOPE-estimated survival probabilities in extreme cases

Resusc Plus. 2021 May 26:7:100139. doi: 10.1016/j.resplu.2021.100139. eCollection 2021 Sep.

Authors

Tomasz Darocha¹, Olivier Hugli², Sylweriusz Kosiński³, Paweł Podsiadło⁴, David Caillet-Bois⁵, Mathieu Pasquier⁵

Affiliations

¹ Severe Accidental Hypothermia Center, Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Medykow 14, 40-752 Katowice, Poland.
² Emergency Department, Lausanne University Hospital, University of Lausanne, BH 09, CHUV, 1011 Lausanne, Switzerland.
³ Faculty of Health Sciences, Jagiellonian University Medical College, Michałowskiego 12, 31-126 Krakow, Poland.
⁴ Institute of Medical Sciences, Jan Kochanowski University, Al. IX Wieków Kielc 19A, 25-317 Kielce, Poland.
⁵ Department of Emergency Medicine, Lausanne University Hospital, BH 09, 1011 Lausanne, Switzerland.

Abstract

Aim: Patients with hypothermic cardiac arrest may survive with an excellent outcome after extracorporeal life support rewarming (ECLSR). The HOPE (Hypothermia Outcome Prediction after ECLS) score is recommended to guide the in-hospital decision on whether or not to initiate ECLSR in patients in cardiac arrest following accidental hypothermia. We aimed to assess the HOPE-estimated survival probabilities for a set of survivors of hypothermic cardiac arrest who had extreme values for the variables included in the HOPE score.

Methods: Survivors were identified and selected through a systematic literature review including case reports. We calculated the HOPE score for each patient who presented extraordinary clinical parameters.

Results: We identified 12 such survivors. The HOPE-estimated survival probability was ≥10% for all (n = 11) patients for whom we were able to calculate the HOPE score.

Conclusion: Our study confirms the robustness of the HOPE score for outliers and thus further confirms its external validity. These cases also confirm that hypothermic cardiac arrest is a fundamentally different entity than normothermic cardiac arrest. Using HOPE for extreme cases may support the proper calibration of a clinician's prognosis and therapeutic decision based on the survival chances of patients with accidental hypothermic cardiac arrest.

Keywords: Cardiac arrest; Extracorporeal life support rewarming; Hypothermia; Triage.