Dynamic SCAI Shock Grade Is Independently Associated With Circulatory Death After Resuscitation of Out‐of‐Hospital Cardiac Arrest

ABSTRACT Background Cardiogenic shock (CS) is a common complication of patients with resuscitated out‐of‐hospital cardiac arrest (OHCA). Aims This study investigates whether the change in SCAI Shock Grade, measured between hospital and intensive care admission (ICU), is associated with outcome after OHCA. Methods Patients with OHCA of suspected cardiac etiology were included from the King's Out‐of‐Hospital Cardiac Arrest Registry between 2012 and 2021. SCAI Shock Grade was determined on hospital and ICU admission. Patients were categorized into worsening, static, or improving SCAI Grade. The primary endpoint was in‐hospital mortality at 30 days. Predictors of SCAI change and circulatory mortality were assessed using univariable and multivariable regression. Results Of 493 patients (median age 63 years, 77% male), 68% had a shockable rhythm, 80% were witnessed, and 94% had bystander CPR. SCAI Grade between hospital and ICU admission improved in 32% of patients, was static in 43% and deteriorated in 25%. Amongst the overall cohort, circulatory death occurred in 19% of patients and neurological death occurred in 28% of patients. Mortality did not differ between groups based on the change in SCAI grade ( p = 0.2). However, circulatory death was more common in patients with deteriorating SCAI Grade (28%), compared to static (19%) and improving (13%) SCAI ( p = 0.010). Multivariable regression modeling showed that SCAI change was independently associated with circulatory death, along with age, lactate, and MIRACLE 2 score. Conclusion In patients with OHCA complicated by CS, deterioration in SCAI Grade between cardiac center arrival and ICU admission is independently associated with circulatory death.