POTEC (Platelet Count, Oxygen Saturation, Time of CPR, Elective Surgery, and Initial ETCO2) Score for Predicting 24-h Survival After Perioperative Cardiopulmonary Resuscitation: Development and Validation

Abstract

Background: Perioperative Cardiac Arrest (POCA) is a rare but catastrophic event with persistently low survival rates. Existing prediction models often fail to capture the perioperative context or predict short-term outcomes. This study aimed to develop and internally validate the POTEC (Platelet count, Oxygen saturation, Time of cardiopulmonary resuscitation (CPR), Elective surgery, and initial end-tidal carbon dioxide (ETCO2) Score, a simple clinical tool for predicting 24-h survival following perioperative CPR. Methods: We conducted a retrospective cohort study of adult patients (≥18 years) who experienced POCA during or within two hours after non-cardiac surgery under anesthesia at a tertiary university hospital between 2010 and 2023. Multivariable logistic regression was used to identify independent predictors of 24-h survival. The final model’s coefficients were used to construct the POTEC Score, which was internally validated using bootstrapping (1000 replications). Results: Of 321 eligible patients, 65 (20.25%) survived at 24-h. Five variables were independently associated with 24-h survival and included in the POTEC score: preoperative platelet count 100 × 109/L, preoperative oxygen saturation of ≥90% on room air upon arrival in the operating room, CPR duration ≤30 min, elective surgery, and initial end-tidal CO2 between 35 and 45 mmHg. The score demonstrated good discrimination (AuROC = 0.788, 95% CI: 0.73–0.85) and calibration (Hosmer–Lemeshow p = 0.535). A score of 4 points or higher was associated with significantly higher odds of 24-h survival (adjusted OR = 2.78, 95% CI: 2.05–3.79). Model optimism was minimal (0.009) after bootstrapping. Conclusions: The POTEC Score is a clinically practical tool for early risk stratification in patients undergoing perioperative CPR. Its integration into perioperative workflows may aid in timely decision-making and resource prioritization during critical postoperative care.