Neurophysiology for predicting good and poor neurological outcome at 12 and 72 h after cardiac arrest: The ProNeCA multicentre prospective study

Scarpino, Maenia; Carrai, Riccardo; Lolli, Francesco; Lanzo, Giovanni; Spalletti, Maddalena; Valzania, Franco; Lombardi, Maria; Audenino, Daniela; Contardi, Sara; Celani, Maria Grazia; Marrelli, Alfonso; Mecarelli, Oriano; Minardi, Chiara; Minicucci, Fabio; Politini, Lucia; Vitelli, Eugenio; Peris, Adriano; Amantini, A.; Sandroni, Claudio; Grippo, Antonello

doi:10.1016/j.resuscitation.2019.11.014

Cited by 63 publications

(69 citation statements)

References 37 publications

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“…Interestingly, however, and differently from previous reviews, we included recent studies conducted in communities where, for legal and/or cultural reasons, no formal WLST was performed. A false-positive prediction from SSEPs was not observed in any of these studies [59,69,91,101,110]. Nevertheless, the treating team was also not blinded to the SSEP results, therefore, a risk of self-fulfilling bias cannot be completely excluded.…”

Section: Short-latency Somatosensory-evoked Potentials (Sseps)mentioning

confidence: 84%

“…The absence of an N20 SSEP wave from one side combined with low-voltage N20 SSEP wave, on the other side, had 0% FPR for prediction of poor neurological outcome in two studies from the same group conducted on a multicentre cohort [69,110], and its combination with a bilaterally absent N20 SSEP increased the overall sensitivity by 9-10%. This finding, however, needs external validation from further studies.…”

Section: Short-latency Somatosensory-evoked Potentials (Sseps)mentioning

confidence: 94%

“…In two studies conducted on a multicentre cohort [69,110], a low-voltage N20 SSEP wave on one side associated with an absent N20 wave on the opposite side was used for prediction of poor neurological outcome at 12, 24, and 72 h from ROSC. FPR for this sign was 0%.…”

Section: Evoked Potentials (Tables 17 18 19 20 21)mentioning

confidence: 99%

“…22,23,24,25,26,27,28,29,30,31,32,33,34,35,36) In one study [69], an isoelectric EEG, defined as all activity below 2 µV, predicted poor outcome at 12 and 72 h from ROSC with 0% FPR and high precision (95% CIs 0-4%) ( Table 22). In six studies, a suppressed EEG background defined according to the ACNS terminology (i.e., all activity of the record < 10 µV; see ESM Table E4) almost invariably predicted a poor neurological outcome [52,53,61,68,69,72], especially after 16-24 h from ROSC. In studies using continuous EEG recording, sensitivity of suppressed EEG background progressively decreased over the first 48 h after ROSC [61,68], and between ≤ 24 h and 36-72 h after ROSC (Tables 23, 24).…”

Section: And Esm Fig 3)mentioning

confidence: 99%

“…Four studies [53,61,69,110] assessed the accuracy of sporadic, non-rhythmic/periodic discharges on EEG from 0-8 up to 72 h from ROSC. Their specificity was lower than that of rhythmic/periodic discharges (Table 38).…”

Section: Discharges and Seizures (Tables 37 38 39 40 41 42 43)mentioning

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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