Prediction of outcome after cardiac arrest

Edgren, Erik; Hedstrand, U; Nordin, Magnus; Rydin, E.; Ronquist, Gunnar

doi:10.1097/00003246-198709000-00004

Cited by 121 publications

(51 citation statements)

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“…On the basis of existing studies, no clinical neurological signs reliably predict poor outcome Ͻ24 hours after cardiac arrest. 204,205 Among adult patients who are comatose and have not been treated with hypothermia, the absence of both pupillary light and corneal reflexes at Ն72 hours after cardiac arrest predicted poor outcome with high reliability. 204 The absence of vestibulo-ocular reflexes at Ն24 hours (FPR 0%, 95% CI 0% to 14%) 205,206 or Glasgow Coma Scale (GCS) score Ͻ5 at Ն72 hours (FPR 0%, 95% CI 0% to 6%) 204,207,208 are less reliable for predicting poor outcome or were studied only in limited numbers of patients.…”

Section: Neurological Assessmentmentioning

confidence: 99%

Part 9: Post–Cardiac Arrest Care

Peberdy¹,

Callaway²,

Neumar³

et al. 2010

Circulation

1,453

838

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Section: Neurological Assessmentmentioning

confidence: 99%

Part 9: Post–Cardiac Arrest Care

Peberdy¹,

Callaway²,

Neumar³

et al. 2010

Circulation

1,453

838

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“…An absent extensor or abnormal flexion to pain (M1-3) predicted a poor outcome at 12, 24, and 48 hours from ROSC with 57 (37-76)%, 35 (21-52)%, and 10 (3-24)% FPR, respectively 298,303,307 (3 studies, 120 patients; very-low-quality evidence downgraded for very serious bias, serious inconsistency, and very serious imprecision). At 72 hours, the FPR of this sign was 6 (0-29)% 298 (1 study, 27 patients; very-lowquality evidence downgraded for very serious bias and very serious imprecision).…”

Section: Clinical Examinationmentioning

confidence: 99%

“…302,319 For the critical outcome of survival with unfavorable neurologic status or death at 180 days, we identified 6 studies on SSEPs or EEG (733 patients; very-low-quality evidence downgraded for serious or very serious bias and serious or very serious imprecision). 271,303,[320][321][322][323] For the critical outcome of survival with unfavorable neurologic status or death at 1 year, we identified 6 studies on SSEPs or EEG (829 patients; low-or very-low-quality evidence downgraded for serious or very serious bias and very serious imprecision). 306,307,[324][325][326][327] Short-Latency SSEPs.…”

Section: Electrophysiologymentioning

confidence: 99%

“…In 1 study 303 ; 1 study, 72 patients; very-low-quality evidence downgraded for very serious bias and very serious imprecision), while a burst suppression at 72 hours from ROSC predicted poor outcome, with 0 (0-11)% FPR 306 (1 study, 277 patients; very-low-quality evidence downgraded for very serious bias and very serious imprecision).…”

Section: Electrophysiologymentioning

confidence: 99%

See 1 more Smart Citation

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

554

125

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Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

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“…In adult patients comatose after cardiac arrest who had not been treated with therapeutic hypothermia, the following parameters predicted poor outcome (CPC 3 or 4, or death) with a false-positive rate (FPR) of 0%: absent vestibuloocular reflexes at Ն24 hours [(95% CI 0% to 14%)] (LOE P1) 892,893 ; absence of pupillary light and corneal reflex at 72 hours [(95% CI 0% to 9%)](LOE P1) 894 ; GCS Ͻ5 at 48 hours (95% CI 0% to 13%) (LOE P1) 895 and on day 3 (95% CI 0% to 6%) (LOE P2) 896 and a clinical examination score Ͻ15 on day 4 [(95% CI 0% to 18%)(LOE P1). 897 However, in 1 study an absent motor response (GCS motorϭ1) at 72 hours after cardiac arrest predicted poor outcome with a FPR of 5% [(95%CI 2% to 9%] ](LOE P1).…”

Section: Consensus On Sciencementioning

confidence: 99%