Hypothermia Outcome Prediction after Extracorporeal Life Support for Hypothermic Cardiac Arrest Patients: Assessing the Performance of the HOPE Score in Case Reports from the Literature

Nolan Grin, Valentin Rousson, Tomasz Darocha, Olivier Hugli, Pierre-Nicolas Carron, Tobias Zingg and Mathieu Pasquier
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Nolan Grin: School of Medicine, Lausanne University, 1011 Lausanne, Switzerland
Valentin Rousson: Center for Primary Care and Public Health (Unisanté), Lausanne University Hospital, 1010 Lausanne, Switzerland
Tomasz Darocha: Severe Accidental Hypothermia Center, Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 40-001 Katowice, Poland
Olivier Hugli: Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
Pierre-Nicolas Carron: Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
Tobias Zingg: Department of Surgery, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
Mathieu Pasquier: Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland

IJERPH, 2021, vol. 18, issue 22, 1-9

Abstract: Aims : The hypothermia outcome prediction after extracorporeal life support (ECLS) score, or HOPE score, provides an estimate of the survival probability in hypothermic cardiac arrest patients undergoing ECLS rewarming. The aim of this study was to assess the performance of the HOPE score in case reports from the literature. Methods : Cases were identified through a systematic review of the literature. We included cases of hypothermic cardiac arrest patients rewarmed with ECLS and not included in the HOPE derivation and validation studies. We calculated the survival probability of each patient according to the HOPE score. Results : A total of 70 patients were included. Most of them (62/70 = 89%) survived. The discrimination using the HOPE score was good (Area Under the Receiver Operating Characteristic Curve = 0.78). The calibration was poor, with HOPE survival probabilities averaging 54%. Using a HOPE survival probability threshold of at least 10% as a decision criterion for rewarming a patient would have resulted in only five false positives and a single false negative, i.e., 64 (or 91%) correct decisions. Conclusions : In this highly selected sample, the HOPE score still had a good practical performance. The selection bias most likely explains the poor calibration found in the present study, with survivors being more often described in the literature than non-survivors. Our finding underscores the importance of working with a representative sample of patients when deriving and validating a score, as was the case in the HOPE studies that included only consecutive patients in order to minimize the risk of publication bias and lower the risk of overly optimistic outcomes.

Keywords: cardiac arrest; ECMO; ECPR; hypothermia; accidental; potassium; publication bias; resuscitation; selection bias; triage (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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