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; Clinical examination; Coma; Computed tomography; Diffusion magnetic resonance imaging; Neuron-specific enolase; Prognosis; Somatosensory-evoked potentials.

Sandroni, C., D'arrigo, S., 1, S. C., W E Hoedemaekers 4, C., J A Kamps 5, M., 6, M. O., S Taccone 7, F., 8, A. D. R., J A Meijer 9, F., Westhall 10, E., Antonelli, M., Soar 11, J., P Nolan 12, J., Cronberg, T., Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review, <<INTENSIVE CARE MEDICINE>>, 2020; (10): 1803-1851. [doi:10.1007/s00134-020-06198-w] [http://hdl.handle.net/10807/166307]

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

Claudio Sandroni;Sonia D'Arrigo;Massimo Antonelli;
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). Keywords: Cardiac arrest; Clinical examination; Coma; Computed tomography; Diffusion magnetic resonance imaging; Neuron-specific enolase; Prognosis; Somatosensory-evoked potentials.
Inglese
Sandroni, C., D'arrigo, S., 1, S. C., W E Hoedemaekers 4, C., J A Kamps 5, M., 6, M. O., S Taccone 7, F., 8, A. D. R., J A Meijer 9, F., Westhall 10, E., Antonelli, M., Soar 11, J., P Nolan 12, J., Cronberg, T., Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review, <>, 2020; (10): 1803-1851. [doi:10.1007/s00134-020-06198-w] [http://hdl.handle.net/10807/166307]
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/166307
Citazioni
  • ???jsp.display-item.citation.pmc??? 25
  • Scopus 66
  • ???jsp.display-item.citation.isi??? 70
social impact