CREST Model for prediction of circulatory etiology death

CREST Model for prediction of circulatory etiology death

CREST Model for very early prediction of circulatory etiology death in patients resuscitated after cardiac arrest and admitted to intensive care unit, but without an ST elevation myocardial infarction from the International Cardiac Arrest Registry (INTCAR) [1] seems to be a promising tool.

The CREST model considers the following factors:

  1. Coronary artery disease

  2. Initial heart rhythm

  3. Low ejection fraction

  4. Shock at the time of admission

  5. Ischemic time more than 25 minutes

Shock at presentation was defined as systolic blood pressure less than 90 mm Hg in the first hour of hospitalisation, despite fluid resuscitation and pressor support or the need for intra-aortic balloon pump. Ejection fraction was assessed within 12 hours of admission by echocardiogram. Ischemic time was from the time of arrest to return of spontaneous circulation sufficient enough to be admitted to intensive care unit. Initial rhythm was considered shockable if ventricular tachycardia or fibrillation and non shockable if pulseless electrical activity or asystole. Score of 0 or 1 gave a risk of circulatory etiology death just above 10% while score 2 elevated it around 20% and score of 3 around 30%. While a score of 4 raised it around 35%, a score of 5 raised it above 50%.

The authors suggest that as circulatory etiology death is around one third in this type of patients, the CREST model may allow patients with less of brain injury to be assigned more mechanical circulatory support and possible efforts at revascularization to improve survival. For this to be effective, brain injury assessment methods like processed electroencephalography may have to be combined with the CREST model.

Reference

1. Bascom KE, Dziodzio J, Vasaiwala S, Mooney M, Patel N, McPherson J, McMullan P, Unger B, Nielsen N, Friberg H, Riker RR, Kern KB, Duarte CW, Seder DB; International Cardiac Arrest Registry (INTCAR). 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. Circulation. 2018 Jan 16;137(3):273-282.