Investigating the predictive effect of FO-FAR 2, CASPRI scores, and end-tidal carbon dioxide levels on neurological survival outcomes of in-hospital cardiac arrest pati̇ents

Cardiopulmonary arrest (CPA) is a critical condition frequently encountered in emergency departments, characterized by high mortality rates and the risk of neurological sequelae. Predicting neurological survival is crucial for enhancing the efficiency of resource utilization and supporting ethical treatment decisions. The aim of this study is to evaluate whether the combined use of the Good Outcome Following Attempted Resuscitation (GO-FAR) 2 and Cardiac Arrest Survival Post-Resuscitation In-hospital (CASPRI) scores with end-tidal carbon dioxide (ETCO₂) levels improves the predictive accuracy of neurological survival in patients who experienced in-hospital cardiac arrest. This prospective observational study was conducted in the Emergency Department of Düzce University Medical Faculty Hospital between January 1 and December 31, 2024. A total of 98 patients who experienced in-hospital cardiac arrest were included. ETCO₂ levels were measured at 0, 10, and 20 minutes following intubation using an EMMA® mainstream capnograph. Neurological survival was assessed using the Cerebral Performance Category (CPC) scale. The median age of patients was 75 years (IQR: 64.50–83.25), with 51% (n=50) being male. Overall, 82.7% (n=81) of the patients died in the hospital, and only 10 patients (10.2%) were discharged with favorable neurological outcomes. While the GO-FAR 2 and CASPRI scores demonstrated good and very good predictive power (GO-FAR 2: AUC = 0.76; CASPRI: AUC = 0.86), the addition of an ETCO₂ 0–20 minute difference >5.5 mmHg significantly their predictive performance to an excellent level (AUCs of 0.94 and 0.96, respectively). This study demonstrated that integrating the ETCO₂ 0–20 minute difference >5.5 mmHg into existing scoring systems such as GO-FAR 2 and CASPRI significantly improves the accuracy of predicting neurological survival. This integration may be beneficial in clinical decision-making processes, particularly in decisions regarding do-not-resuscitate (DNR) orders. Keywords: CASPRI, GO-FAR, ETCO₂, Cardiopulmonary Arrest, Neurological Survival