GO-FAR

Embryology, the study of human fetal development, was one of the few truly elective classes I took in pursuit of a zoology degree many years ago.  It was a class of maybe twenty students, with only one other woman in there, obviously pregnant.  While we covered normal fetal development, of course there was a lot of focus on everything that could go wrong all along the way.  I was grateful not to be the pregnant one—I would have worried about everything. 

Along the way we learned about amazing advances as well, including in utero surgery, which perhaps hasn’t gone as well as early research suggested, since I don’t see much about it. 

What I learned in that class served me well 14 years later when my obstetrician informed us at 18 weeks’ gestation that our baby had no kidneys.  There was nothing to be done.  No recourse. 

The idea that medicine can’t fix everything is a concept that many Americans raised to believe in fairy tales and safety nets and the miracles of modern medicine and big government cannot comprehend.  There will come a time when we have to say farewell to our loved ones.  And that will happen with greater frequency when our medical system collapses. 

I’m pretty sure it was one of the first topics covered in a course I took with Dr. Steve.  CPR is for dead people.  You don’t do CPR in a collapse, except in the case of lightning strikes, choking, or drowning.  Those people were healthy before the accident and have a reasonable chance of full recovery.  The rest are not, and without modern medicine and drugs to sustain them, they will not survive.  And in the meantime, they consume resources that could be used to save many others. 

Which brings us to the GO-FAR score.  Good Outcome Following Attempted Resuscitation predicts how likely a patient is to survive until discharge with a good outcome (reasonable mental capacity) after an in-hospital cardiac arrest.

GO-FAR  score.  Use pre-arrest information to calculate
Age, years	<70	0
	70-74	+2
	75-79	+5
	80-84	+6
	85+	+11
	No	Yes
Neurologically intact or minimal deficits at admission	0	--15
Major trauma, injury associated with shock or altered mental status during current admission	0	+10
Acute stroke, ischemic or hemorrhagic, during current admission	0	+8
Metastatic or hematologic cancer	0	+7
Septicemia, documented bloodstream infection with antibiotics not yet started or ongoing	0	+7
Medical non-cardiac diagnosis on admission	0	+7
Hepatic insufficiency, total bilirubin>2 mg/dL or 34 µmol/L and AST >2x upper limit of normal, or cirrhosis	0	+6
Admit from skilled nursing facility	0	+6
Hypotension or hypoperfusion within 4 hrs prior to arrest SBP <90, MAP <60, pressors or inotropes other than dopamine ≤3 µmol/kg/min after volume expansion, or intra-aortic balloon pump	0	+5
Renal insufficiency or dialysis	0	+4
Respiratory insufficiency Any of the following: P/F ratio <300, PaO₂ <60, SaO₂ <90%; PaCO₂, ETCO₂, or transcutaneous CO₂ >50, spontaneous RR >40 or <5, or noninvasive or invasive ventilation	0	+4
Pneumonia, documented active pneumonia with antibiotics not yet started or still ongoing	0	+1

Total all points in the Yes column.   GO-FAR Score Risk group Survival to discharge with minimal neurologic disability[1] >24 Very low survival <1% 14-23 Low survival 1-3% --5-13 Average survival 3-15% --15---6 Above average survival >15%
Remember, this calculation is for in-hospital cardiac arrests with all the advantages of modern medicine.  The patient is already at the hospital.  All the best doctors—trained for these patients—and the technology and medications are right there.  And still, the odds for survival are not spectacular.  What happens to those odds when there is no hospital, no skilled physicians, and no medications?  Perhaps we need to consider the reality of the situation now.  References: https://www.mdcalc.com/calc/10033/go-far-good-outcome-following-attempted-resuscitation-score#why-use Links to related posts:

Triage 

The Inevitable Consequences of a Collapsed Medical System

Rationing Care and Supplies 

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[1] Patient is conscious, alert, able to work but may have mild neurologic or psychological deficits.