Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review
- PDF / 1,577,333 Bytes
- 49 Pages / 595.276 x 790.866 pts Page_size
- 11 Downloads / 198 Views
SYSTEMATIC REVIEW
Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review Claudio Sandroni1,2, Sonia D’Arrigo1* , Sofia Cacciola1, Cornelia W. E. Hoedemaekers3, Marlijn J. A. Kamps4, Mauro Oddo5, Fabio S. Taccone6, Arianna Di Rocco7, Frederick J. A. Meijer8, Erik Westhall9, Massimo Antonelli1,2, Jasmeet Soar10, Jerry P. Nolan11 and Tobias Cronberg12 © 2020 The Author(s)
Abstract Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3–5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013–April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results: Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2–5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion: In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169) Keywords: Cardiac arrest, Coma, Prognosis, Clinical examination, Somatosensory-evoked potentials, Neuron-specific enolase, Computed tomography, Diffusion magnetic resonance imaging
*Correspondence: [email protected] 1 Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario “Agostino Gemelli”- IRCCS, Largo Francesco Vito, 1, 00168 Rome, Italy Full author information is available at the end of the article Jerry P. Nolan and Tobias Cronberg have contributed equally to this manuscript.
Key messages from the 2020 evidence review This review follows those published previously in 2013 and will inform the upcoming European Resuscitation Council and European Society of Intensive Care Medicine (ERC-ESICM) Guidelines on Post-Resuscitation Care. Given the complexity and volume of evidence, we have summarised our main findings i
Data Loading...
