Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C

Roman-Pognuz, Erik; Elmer, Jonathan; Guyette, Francis X.; Poillucci, Gabriele; Lucangelo, Umberto; Berlot, Giorgio; Manganotti, Paolo; Peratoner, Alberto; Pellis, Tommaso; Taccone, Fabio Silvio; Callaway, Clifton W.

doi:10.3390/jcm10061331

Cited by 6 publications

(7 citation statements)

References 36 publications

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“…Predicting neurological outcome with a single predictor can induce false positives, which was confirmed in our study. Our results provide further evidence that a multimodal approach could reduce erroneous prognostication [ 24 , 25 ]. In particular, caution is required to predict the patient's outcome using NSE and brain CT because 3 patients with NSE 60 and 9 patients with poor CT were false positives in the first cohort.…”

Section: Discussionsupporting

confidence: 60%

External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

et al. 2022

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Purpose To assess the performance of the post-cardiac arrest (CA) prognostication strategy algorithm recommended by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) in 2020. Methods This was a retrospective analysis of the Korean Hypothermia Network Prospective Registry 1.0. Unconscious patients without confounders at day 4 (72–96 h) after return of spontaneous circulation (ROSC) were included. The association between the prognostic factors included in the prognostication strategy algorithm, except status myoclonus and the neurological outcome, was investigated, and finally, the prognostic performance of the prognostication strategy algorithm was evaluated. Poor outcome was defined as cerebral performance categories 3–5 at 6 months after ROSC. Results A total of 660 patients were included in the final analysis. Of those, 108 (16.4%) patients had a good neurological outcome at 6 months after CA. The 2020 ERC/ESICM prognostication strategy algorithm identified patients with poor neurological outcome with 60.2% sensitivity (95% CI 55.9–64.4) and 100% specificity (95% CI 93.9–100) among patients who were unconscious or had a GCS_M score ≤ 3 and with 58.2% sensitivity (95% CI 53.9–62.3) and 100% specificity (95% CI 96.6–100) among unconscious patients. When two prognostic factors were combined, any combination of prognostic factors had a false positive rate (FPR) of 0 (95% CI 0–5.6 for combination of no PR/CR and poor CT, 0–30.8 for combination of No SSEP N20 and NSE 60). Conclusion The 2020 ERC/ESICM prognostication strategy algorithm predicted poor outcome without an FPR and with sensitivities of 58.2–60.2%. Any combinations of two predictors recommended by ERC/ESICM showed 0% of FPR.

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Section: Discussionsupporting

confidence: 60%

External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

et al. 2022

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“…In our study the population was similar to previous studies regarding age, sex and mortality [2,4,5,9,12,[18][19][20]. The proportions of myocardial ischemia as the cause of resuscitation and shockable rhythm in our population were also similar to those found in the literature in larger studies [4,18].…”

Section: Discussionsupporting

confidence: 89%

Early Bronchoscopy Improves Extubation Rates after Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Analysis

Zimmermann

Palm

Lahmann

et al. 2021

JCM

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Background: Patients suffering from out-of-hospital cardiac arrest (OHCA) frequently receive a bronchoscopy after being admitted to the ICU. We investigated the optimal timing and the outcome in these patients. Methods: All patients who suffered from OHCA and were treated in our ICU from January 2013 to December 2018 were retrospectively analyzed. The data were collected from the patients’ medical files, and included duration of mechanical ventilation, antibiotics, microbiological test results and neurological outcome. The outcome was the effect of early bronchoscopy (≤48 h after administration) on the rate of intubated patients on day five and day seven. Results: From January 2013 to December 2018, 190 patients were admitted with OHCA. Bronchoscopy was performed in 111 patients out of the 164 patients who survived the first day. Late bronchoscopy >48 h was associated with higher rates of intubation on day five (OR 4.94; 95% CI 1.2–36.72, 86.7% vs. 55.0%, p = 0.036) and day seven (OR 4.96; 95% CI 1.38–24.69; 80.0% vs. 43.3%, p = 0.019). Conclusion: This study shows that patients who suffered from OHCA might have a better outcome if they receive a bronchoscopy early after hospital admission. Our data suggests an association of early bronchoscopy with a shorter intubation period.

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“…Finally, we also evaluated the relationship between SSEP amplitudes and other demographic and prognostic markers, and we assessed the prognostic value of different combinations. Indeed, using the most specific predictors with the higher specificity and so the lowest FPR and combined predictors maximize safety of neuro-prognostication after CA [2,28], as we highlighted in our study.…”

Section: Discussionmentioning

confidence: 53%

“…Lowering the N20-baseline 3). Regarding the second SSEP component i.e N20-P25, an amplitude > 3.2 µV predicted good outcome with a specificity of 93 [90-96]% and sensitivity of 29 [23][24][25][26][27][28][29][30][31][32][33][34]%, although a threshold of 4 µV increased specificity (sp = 95 [92-97] %) but decreased sensitivity (se = 14 [10-18]%) (Table 3). The combination of N20-baseline > 2 µV with a benign EEG presented a higher specificity (sp = 96.9 [95-99]%) with a similar sensitivity (se = 33.3 [28-39]%) although combination of N20-P25 with benign EEG was also highly specific (sp = 97 [93-98]%) but poorly sensitive (se = 17 [13-21]%).…”

Section: Prediction Of Good Outcomementioning

confidence: 99%

SSEP N20 and P25 amplitudes predict poor and good neurologic outcomes after cardiac arrest

Benghanem

Nguyen

Gavaret

et al. 2022

Ann. Intensive Care

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Background To assess in comatose patients after cardiac arrest (CA) if amplitudes of two somatosensory evoked potentials (SSEP) responses, namely, N20-baseline (N20-b) and N20–P25, are predictive of neurological outcome. Methods Monocentric prospective study in a tertiary cardiac center between Nov 2019 and July-2021. All patients comatose at 72 h after CA with at least one SSEP recorded were included. The N20-b and N20–P25 amplitudes were automatically measured in microvolts (µV), along with other recommended prognostic markers (status myoclonus, neuron-specific enolase levels at 2 and 3 days, and EEG pattern). We assessed the predictive value of SSEP for neurologic outcome using the best Cerebral Performance Categories (CPC1 or 2 as good outcome) at 3 months (main endpoint) and 6 months (secondary endpoint). Specificity and sensitivity of different thresholds of SSEP amplitudes, alone or in combination with other prognostic markers, were calculated. Results Among 82 patients, a poor outcome (CPC 3–5) was observed in 78% of patients at 3 months. The median time to SSEP recording was 3(2–4) days after CA, with a pattern “bilaterally absent” in 19 patients, “unilaterally present” in 4, and “bilaterally present” in 59 patients. The median N20-b amplitudes were different between patients with poor and good outcomes, i.e., 0.93 [0–2.05]µV vs. 1.56 [1.24–2.75]µV, respectively (p < 0.0001), as the median N20–P25 amplitudes (0.57 [0–1.43]µV in poor outcome vs. 2.64 [1.39–3.80]µV in good outcome patients p < 0.0001). An N20-b > 2 µV predicted good outcome with a specificity of 73% and a moderate sensitivity of 39%, although an N20–P25 > 3.2 µV was 93% specific and only 30% sensitive. A low voltage N20-b < 0.88 µV and N20–P25 < 1 µV predicted poor outcome with a high specificity (sp = 94% and 93%, respectively) and a moderate sensitivity (se = 50% and 66%). Association of “bilaterally absent or low voltage SSEP” patterns increased the sensitivity significantly as compared to “bilaterally absent” SSEP alone (se = 58 vs. 30%, p = 0.002) for prediction of poor outcome. Conclusion In comatose patient after CA, both N20-b and N20–P25 amplitudes could predict both good and poor outcomes with high specificity but low to moderate sensitivity. Our results suggest that caution is needed regarding SSEP amplitudes in clinical routine, and that these indicators should be used in a multimodal approach for prognostication after cardiac arrest.

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Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C

Cited by 6 publications

References 36 publications

External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

Early Bronchoscopy Improves Extubation Rates after Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Analysis

SSEP N20 and P25 amplitudes predict poor and good neurologic outcomes after cardiac arrest

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