CAHP (Cardiac Arrest Hospital Prognosis) Score

• A high CAHP score does not obviate the need for ongoing monitoring, detailed neurologic assessment, ICU care, etc.
• High CAHP scores (>200) in the ED should not be used to withhold or withdraw standard care for any OHCA patient with ROSC such as ICU admission, therapeutic hypothermia, neurologic consultation, critical care management and other high quality post-resuscitation care.
• Scores do not provide individual prediction and should therefore not be used alone to make a decision regarding aggressiveness of care. This should be made on an individualized basis based on all clinical factors by all clinical teams involved.
• It is advisable to consult interventional cardiology for all OHCA patients with ROSC.

• For patients with high risk CAHP scores (>200), the majority of patients will not have a good neurologic outcome and aggressive care may not result in improved outcomes.
• For patients with intermediate scores (150-200), a case by case decision including all clinical variables should be made.
• For patients with low CAHP scores (<150), emergency, early or deferred coronary angiography is appropriate depending on clinical circumstances. Patient with active ischemic EKG or high risk EKG changes, persistent hypotension/shock, recurrent malignant arrhythmia or arrest may need immediate cath. In other patients without such high risk features, a deferred approach after neurologic improvement may be appropriate.

Patient scoring less than 150 with no other obvious cause of cardiac arrest should be considered for early vs delayed coronary angiography depending on whether the patients have the following high risk features:

1. All STEMI (immediate coronary angiography unless obvious contra-indication-consult cath lab immediately).
2. High risk EKG abnormality apart from STEMI.
3. Recurrent arrhythmia or arrest.
4. Shock.

Ensure complete history is obtained from EMS or witnesses regarding accuracy of timing.