Performance of a guideline-recommended algorithm for prognostication of poor neurological outcome after cardiac arrest
| Autor: | Niklas Mattsson-Carlgren, Gisela Lilja, Sofia Backman, Christian Rylander, Jesper Kjaergaard, Hans Friberg, Niklas Nielsen, Anna Lybeck, Pascal Stammet, Irina Dragancea, Tobias Cronberg, Marion Moseby-Knappe, Erik Westhall, Susann Ullén, Christian Hassager, Janneke Horn |
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| Přispěvatelé: | Intensive Care Medicine, ANS - Neuroinfection & -inflammation |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Resuscitation
medicine.medical_specialty Neurology Original Prognostication Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Hypothermia Induced Anesthesiology Prognostic accuracy medicine Humans Coma Neuroradiology Retrospective Studies business.industry Glasgow Coma Scale 030208 emergency & critical care medicine Guideline Prognosis Cardiac arrest Cardiopulmonary Resuscitation Heart Arrest 030228 respiratory system Guideline algorithm Phosphopyruvate Hydratase Cohort medicine.symptom business Algorithm Algorithms Out-of-Hospital Cardiac Arrest |
| Zdroj: | Intensive care medicine, 46(10), 1852-1862. Springer Verlag Moseby-Knappe, M, Westhall, E, Backman, S, Mattsson-Carlgren, N, Dragancea, I, Lybeck, A, Friberg, H, Stammet, P, Lilja, G, Horn, J, Kjaergaard, J, Rylander, C, Hassager, C, Ullén, S, Nielsen, N & Cronberg, T 2020, ' Performance of a guideline-recommended algorithm for prognostication of poor neurological outcome after cardiac arrest ', Intensive Care Medicine, vol. 46, no. 10, pp. 1852-1862 . https://doi.org/10.1007/s00134-020-06080-9 Intensive Care Medicine |
| ISSN: | 0342-4642 |
| DOI: | 10.1007/s00134-020-06080-9 |
| Popis: | Purpose To assess the performance of a 4-step algorithm for neurological prognostication after cardiac arrest recommended by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM). Methods Retrospective descriptive analysis with data from the Target Temperature Management (TTM) Trial. Associations between predicted and actual neurological outcome were investigated for each step of the algorithm with results from clinical neurological examinations, neuroradiology (CT or MRI), neurophysiology (EEG and SSEP) and serum neuron-specific enolase. Patients examined with Glasgow Coma Scale Motor Score (GCS-M) on day 4 (72–96 h) post-arrest and available 6-month outcome were included. Poor outcome was defined as Cerebral Performance Category 3–5. Variations of the ERC/ESICM algorithm were explored within the same cohort. Results The ERC/ESICM algorithm identified poor outcome patients with 38.7% sensitivity (95% CI 33.1–44.7) and 100% specificity (95% CI 98.8–100) in a cohort of 585 patients. An alternative cut-off for serum neuron-specific enolase, an alternative EEG-classification and variations of the GCS-M had minor effects on the sensitivity without causing false positive predictions. The highest overall sensitivity, 42.5% (95% CI 36.7–48.5), was achieved when prognosticating patients irrespective of GCS-M score, with 100% specificity (95% CI 98.8–100) remaining. Conclusion The ERC/ESICM algorithm and all exploratory multimodal variations thereof investigated in this study predicted poor outcome without false positive predictions and with sensitivities 34.6–42.5%. Our results should be validated prospectively, preferably in patients where withdrawal of life-sustaining therapy is uncommon to exclude any confounding from self-fulfilling prophecies. Electronic supplementary material The online version of this article (10.1007/s00134-020-06080-9) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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