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Open Access 01-10-2020 | Computed Tomography | Systematic Review

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Authors: Claudio Sandroni, Sonia D’Arrigo, Sofia Cacciola, Cornelia W. E. Hoedemaekers, Marlijn J. A. Kamps, Mauro Oddo, Fabio S. Taccone, Arianna Di Rocco, Frederick J. A. Meijer, Erik Westhall, Massimo Antonelli, Jasmeet Soar, Jerry P. Nolan, Tobias Cronberg

Published in: Intensive Care Medicine | Issue 10/2020

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)

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Title: Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review
Authors: Claudio Sandroni
Sonia D’Arrigo
Sofia Cacciola
Cornelia W. E. Hoedemaekers
Marlijn J. A. Kamps
Mauro Oddo
Fabio S. Taccone
Arianna Di Rocco
Frederick J. A. Meijer
Erik Westhall
Massimo Antonelli
Jasmeet Soar
Jerry P. Nolan
Tobias Cronberg
Publication date: 01-10-2020
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Evoked Potential
Somatosensory Evoked Potential
Electroencephalography
Somatosensory Evoked Potential
Evoked Potential
Published in: Intensive Care Medicine / Issue 10/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06198-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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