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

Autor: Sandroni C; Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario 'Agostino Gemelli'- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.; Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy., D'Arrigo S; Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario 'Agostino Gemelli'- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy. sonia.darrigo@policlinicogemelli.it., Cacciola S; Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario 'Agostino Gemelli'- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy., Hoedemaekers CWE; Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands., Kamps MJA; Intensive Care Catharina Hospital Eindhoven, Eindhoven, The Netherlands., Oddo M; Department of Intensive Care Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland., Taccone FS; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium., Di Rocco A; Department of Public Health and Infectious Disease, Sapienza University, Rome, Italy., Meijer FJA; Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands., Westhall E; Department of ClinicalSciences, Clinical Neurophysiology, Lund University, Skane University Hospital, Lund, Sweden., Antonelli M; Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario 'Agostino Gemelli'- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.; Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy., Soar J; Critical Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK., Nolan JP; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK., Cronberg T; Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2020 Oct; Vol. 46 (10), pp. 1803-1851. Date of Electronic Publication: 2020 Sep 11.
DOI: 10.1007/s00134-020-06198-w
Abstrakt: 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).
Databáze: MEDLINE
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