Early prognostication markers in cardiac arrest patients treated with hypothermia

Abstract

Background and purpose Established prognostication markers, such as clinical findings, electroencephalography (EEG), and biochemical markers, used by clinicians to predict neurologic outcome after cardiac arrest (CA) are altered under therapeutic hypothermia (TH) conditions and their validity remains uncertain. Methods MEDLINE and EMBASE were searched for evidence on the current standards for neurologic outcome prediction for out-of-hospital CA patients treated with TH and the validity of a wide range of prognostication markers. Relevant studies that suggested one or several established biomarkers, and multimodal approaches for prognostication were included and reviewed. Results While the prognostic accuracy of various tests has been questioned after TH, pupillary light reflexes and somatosensory evoked potentials (SSEP) are still strongly associated with negative outcome for early prognostication. Increasingly, EEG background activity has also been identified as a valid predictor for outcome after 72 hours after CA and a preferred prognostic method in clinical settings. Neuroimaging techniques, such as MRI and CT, can identify functional and structural brain injury, but are not readily available at the patient’s bedside because of limited availability and high costs. Conclusions A multimodal algorithm composed of neurological examination, EEG-based quantitative testing, and SSEP, in conjunction with newer MRI sequences, if available, holds promise for accurate prognostication in CA patients treated with TH. In order to avoid premature withdrawal of care, prognostication should be performed later than 72 hours after CA.

Early-SEPs’ amplitude reduction is reliable for poor-outcome prediction after cardiac arrest?

“…Council, the European Society of Intensive Care Medicine 34 and the Task Force for Belgian recommendations 5 have suggested a multimodal approach for the neurological prognostic assessment of CA patients. Furthermore, recent papers have reported that EEG markers can predict outcomes with relatively high specificity and sensitivity, 6 and that a multimodal approach incorporating more tools must always include EEG. 5 However, only a few papers have analysed the association between SEP and EEG in CA patients for prognostic purposes, 23,24 and none have performed a detailed analysis of EEG patterns in patients with a marked reduction in SEPs.…”

“…6 The bilateral absence of cortical somatosensory evoked potentials (SEPs) is currently considered one of the most reliable predictors of poor outcome. 6 The bilateral absence of cortical somatosensory evoked potentials (SEPs) is currently considered one of the most reliable predictors of poor outcome.…”

“…focused on poor prognosis. 6 The bilateral absence of cortical somatosensory evoked potentials (SEPs) is currently considered one of the most reliable predictors of poor outcome. 7 However, this predictor has low sensitivity; in fact, no more than 40% of all CA patients show this SEP pattern.…”

Advances and insights into neurological practice 2016−17

“…Neuromuscular disorders , trauma , neuro‐inflammation , headache and more general neurological topics complete the 2016 spectrum of the Journal's purview.…”

“…Neuromuscular disorders , trauma [214,215], neuro-inflammation [216][217][218][219][220][221][222][223], headache [224][225][226][227][228][229][230][231] and more general neurological topics [232][233][234][235][236][237][238][239][240][241][242][243][244][245][246][247][248]…”