Early bedside clinical predictors for neurological outcome and survival of post-cardiac arrest patients- a prospective observational study.

This prospective observational study aims to identify early bedside clinical predictors of neurological outcome and survival in adult post-cardiac arrest patients who achieve sustained return of spontaneous circulation. The study will be conducted in the emergency department and intensive care units of a tertiary care hospital and will include patients aged more than 18 years with both in-hospital and out-of-hospital cardiac arrest. The primary objective is to assess early bedside clinical parameters associated with mortality and discharge neurological outcomes. The secondary objectives are to develop a simplified multimodal bedside prognostic score and to compare the predictive ability of these parameters between in-hospital and out-of-hospital cardiac arrest patients. Early, readily available bedside parameters, including neurological, respiratory, hemodynamic, and metabolic variables, will be recorded at predefined time points: 1st hour, 2nd hour, 6th hour, 12th hour, and 24 hours after return of spontaneous circulation. These variables include Glasgow Coma Scale, pupillary reflexes, end-tidal carbon dioxide, ventilatory parameters, vital signs, and arterial blood gas values, as available in routine care. The outcomes will be neurological status at discharge assessed using cerebral performance category score, and in-hospital mortality, length of intensive care unit stay, ventilator-free days, and withdrawal of life-sustaining therapy. Based on these predictors, a simplified multimodal bedside prognostic score will be developed. The study also aims to compare the predictive ability of these parameters between in-hospital and out-of-hospital cardiac arrest patients. This study is observational and does not involve any additional interventions beyond standard clinical care. Patients who re-arrest within 30 minutes of initial return of spontaneous circulation will be excluded from the study, as they will not meet the definition of sustained return of spontaneous circulation. Patients who are re-arrested after 30 minutes and achieve return of spontaneous circulation again will continue to be followed, and data collection will proceed as per protocol, whereas those who do not achieve return of spontaneous circulation will be included in mortality outcomes with data recorded until the time of re-arrest. The findings are expected to help in early risk stratification and development of a simple, cost-effective bedside prognostic model for use in resource-limited settings.