Investigation of Pathophysiology, Intensive Care Procedures, Prognostic and Mortality Factors in Conditions Requiring Cardiopulmonary Resuscitation
Kiss Boldizsár
Cardiovascular Medicine and Research Division
Dr. Merkely Béla
SE Városmajori Klinikák Tanterme
2026-10-26 15:00:00
Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Dr. Merkely Béla
Dr. Zima Endre István
Dr. Lex Dániel
Dr. Piróth Zsolt
Dr. Benyó Zoltán
Dr. Jambrik Zoltán
Dr. Barta Judit
This thesis summarizes outcome prediction and age-related determinants in OHCA
through two linked research components: a systematic review and meta-analysis of
prognostic scoring systems and a nationwide HNAS registry analysis focused on age–
treatment effect modification.
The systematic review identified 51 eligible studies (86,321 patients) describing 36
prognostic scoring systems or models; 24 studies (13,261 patients) were included in
quantitative synthesis. Predictor sets and cohorts were highly heterogeneous, and most
datasets predated major shifts in post-resuscitation care (e.g., widespread targeted
temperature management). Across scores eligible for meta-analysis, neurological
outcome at hospital discharge was most frequently reported. CAHP demonstrated the
highest pooled discrimination for poor neurological outcome at discharge (AUC 0.876;
95% CI, 0.853–0.898), while C-GRApH showed the lowest (AUC 0.764; 95% CI, 0.738–
0.791). Additional SROC and threshold-based analyses supported CAHP’s superior
performance in high-specificity ranges, consistent with a “rule-in poor outcome” use
case.
The registry analysis included 147,962 adult OHCAs with attempted resuscitation (2018–
2025), with 8.8% survival to hospital admission. Increasing age was associated with a
progressive survival disadvantage (2% lower odds per year). VF/VT, medical witness,
bradycardia, and AED shock delivery were the strongest independent predictors; the final
multivariable model showed good discrimination (AUC 0.784) and calibration. After
false discovery rate correction, significant age interactions indicated attenuation of the
survival advantage associated with female sex and shockable rhythm with advancing age,
while time-critical interventions retained substantial benefit across age strata.
The thesis concludes that CAHP is the most robust early score for discharge neurological
outcome prediction and that age influences both baseline prognosis and the magnitude of
certain predictors, yet should not drive therapeutic neglect. It emphasizes standardized
registry-based validation, high-specificity performance reporting, and external
validation/recalibration before implementation of real-time decision-support tools.
