Late awakening, prognostic factors and long-term outcome in out-of-hospital cardiac arrest – results of the prospective Norwegian Cardio-Respiratory Arrest Study (NORCAST)

Nakstad, Espen Rostrup; Stær-Jensen, Henrik; Wimmer, Henning; Henriksen, Julia; Alteheld, Lars; Reichenbach, Antje S.; Drægni, Tomas; Šaltytė‐Benth, Jūratė; Wilson, John; Etholm, Lars; Øijordsbakken, Miriam; Eritsland, Jan; Seljeflot, Ingebjørg; Jacobsen, Dag; Andersen, Geir Øystein; Lundqvist, Christofer; Sunde, Kjetil

doi:10.1016/j.resuscitation.2019.12.031

Cited by 52 publications

(58 citation statements)

References 38 publications

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“…In some studies included in our review [44,105], the NSE thresholds for 0% FPR were very high, with a concurrent low sensitivity, especially at 24 and 48 h after ROSC (see Table 14). This was because of the presence of outliers in the group of patients with good neurological outcome.…”

Section: Nsementioning

confidence: 99%

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

et al. 2020

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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

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Section: Nsementioning

confidence: 99%

“…Sensitivities ranged from 7.6% and 56%, from 24.6% and 60.2%, and from 39.3% and 52.6%, respectively. Two studies documented 0% FPR for NSE at 4 days [42,47], 2 at 5 days [42,105], and 1 at 7 days after ROSC [105] (Table 14).…”

Section: Biomarkers (Tables 14 15 16)mentioning

confidence: 99%

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

et al. 2020

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“…3 A combination of different prognostic factors must be available ('multimodal prognostication') in addition to staff with relevant expertise to enable identification of conditions with a poor outcome. 3,7,38 Patients who are reliably predicted to be destined to have a poor outcome, should be evaluated for potential organ donation, either after circulatory or brain death. This opportunity is often missed because of the lack of an organ donation programme in the hospital or restrictive regulations concerning organ function, patient age or other factors.…”

Section: In-hospital Treatment Of the Ohca Patientmentioning

confidence: 99%

“…3 A combination of different prognostic factors must be available (‘multimodal prognostication’) in addition to staff with relevant expertise to enable identification of conditions with a poor outcome. 3,7,38…”

Section: The Functions Of the Cacmentioning

confidence: 99%

The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause – aims, function and structure: Position paper of the Association for Acute CardioVascular Care of the European Society of Cardiology (AVCV), European Association of Percutaneous Coronary Interventions (EAPCI), European Heart Rhythm Association (EHRA), European Resuscitation Council (ERC), European Society for Emergency Medicine (EUSEM) and European Society of Intensive Care Medicine (ESICM)

Sinning¹,

Ahrens

Cariou

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Approximately 10% of patients resuscitated from out-of-hospital cardiac arrest survive to hospital discharge. Improved management to improve outcomes is required, and it is proposed that such patients should be preferentially treated in cardiac arrest centres. The minimum requirements of therapy modalities for the cardiac arrest centre are 24/7 availability of an on-site coronary angiography laboratory, an emergency department, an intensive care unit, imaging facilities such as echocardiography, computed tomography and magnetic resonance imaging, and a protocol outlining transfer of selected patients to cardiac arrest centres with additional resources (out-of-hospital cardiac arrest hub hospitals). These hub hospitals are regularly treating a high volume of patients and offer further treatment modalities. This consensus document describes the aims, the minimal requirements for therapeutic modalities and expertise, and the structure, of a cardiac arrest centre. It represents a consensus among the major European medical associations and societies involved in the treatment of out-of-hospital cardiac arrest patients.

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“…In 21 studies, when bilateral absence of N20 waves was observed in the SSEP conducted at 24 hours or more after ROSC, a poor neurological outcome was predicted with specificity of 50% to 100% and sensitivity of 18.2% to 70.5%. 101,102,114,121,123,127,128,134,[144][145][146][147][148][149][150][151][152][153][154][155][156] Although decrease in the amplitude of N20 is associated with a poor neurological outcome in some studies, further studies are needed. 152,155,157,158 Since there is a high likelihood that results are affected by confounding factors within 24 hours after ROSC, it is recommended to use bilateral absence of N20 waves more than 24 hours after ROSC in combination with other prognostic tests.…”

Section: Electrophysiology Ssepmentioning

confidence: 99%

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

et al. 2021

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The 2020 Korean Post-cardiac Arrest Care Guidelines are medical recommendations derived based on scientific evidence for post-cardiac arrest care. These guidelines are based on the 2020 scientific consensus and treatment recommendations of the International Liaison Committee on Resuscitation and we additionally considered the research papers in the post-cardiac arrest care field which were published after the International Liaison Committee on Resuscitation review. 1,2 In these guidelines, topics which are clinically important and needed further consideration were reviewed in the form of adaptation or hybridization. Meta-analyses or scoping reviews for addi-S42 www.ceemjournal.org 2020 CPR guidelines: post-cardiac arrest care Use of prophylactic antibioticsThe benefit of the routine use of prophylactic antibiotics in pa-S43

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Late awakening, prognostic factors and long-term outcome in out-of-hospital cardiac arrest – results of the prospective Norwegian Cardio-Respiratory Arrest Study (NORCAST)

Cited by 52 publications

References 38 publications

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

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

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

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