TY - JOUR
T1 - Prognostication in comatose survivors of cardiac arrest: An advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine
AU - Sandroni, Claudio
AU - Cariou, Alain
AU - Cavallaro, Fabio
AU - Cronberg, Tobias
AU - Friberg, Hans
AU - Hoedemaekers, Cornelia
AU - Horn, Janneke
AU - Nolan, Jerry P.
AU - Rossetti, Andrea O.
AU - Soar, Jasmeet
PY - 2014
Y1 - 2014
N2 - Objectives: To review and update the evidence on predictors
of poor outcome (death, persistent vegetative state or severe neurological disability) in adult comatose survivors of cardiac arrest, either treated or not treated with controlled
temperature, to identify knowledge gaps and to suggest a reliable prognostication strategy.
Methods: GRADE-based systematic review followed by expert consensus achieved using Web-based Delphi methodology, conference calls and face-to-face meetings. Predictors
based on clinical examination, electrophysiology, biomarkers and imaging were included. Results and conclusions: Evidence from a total of 73 studies was reviewed. The quality of
evidence was low or very low for almost all studies. In patients who are comatose
with absent or extensor motor response at C72 h from arrest, either treated or not
treated with controlled temperature, bilateral absence of either pupillary and
corneal reflexes or N20 wave of shortlatency somatosensory evoked potentials were identified as the most robust predictors. Early status myoclonus, elevated values of neuron-specific enolase
at 48–72 h from arrest, unreactive malignant EEG patterns after rewarming, and presence of diffuse signs of postanoxic injury on either computed tomography or magnetic resonance
imaging were identified as useful but less robust predictors. Prolonged observation and repeated assessments should be considered when results of initial assessment are inconclusive. Although
no specific combination of predictors is sufficiently supported by available evidence, a multimodal prognostication approach is recommended in all patients.
AB - Objectives: To review and update the evidence on predictors
of poor outcome (death, persistent vegetative state or severe neurological disability) in adult comatose survivors of cardiac arrest, either treated or not treated with controlled
temperature, to identify knowledge gaps and to suggest a reliable prognostication strategy.
Methods: GRADE-based systematic review followed by expert consensus achieved using Web-based Delphi methodology, conference calls and face-to-face meetings. Predictors
based on clinical examination, electrophysiology, biomarkers and imaging were included. Results and conclusions: Evidence from a total of 73 studies was reviewed. The quality of
evidence was low or very low for almost all studies. In patients who are comatose
with absent or extensor motor response at C72 h from arrest, either treated or not
treated with controlled temperature, bilateral absence of either pupillary and
corneal reflexes or N20 wave of shortlatency somatosensory evoked potentials were identified as the most robust predictors. Early status myoclonus, elevated values of neuron-specific enolase
at 48–72 h from arrest, unreactive malignant EEG patterns after rewarming, and presence of diffuse signs of postanoxic injury on either computed tomography or magnetic resonance
imaging were identified as useful but less robust predictors. Prolonged observation and repeated assessments should be considered when results of initial assessment are inconclusive. Although
no specific combination of predictors is sufficiently supported by available evidence, a multimodal prognostication approach is recommended in all patients.
KW - Prognosis
KW - coma
KW - heart arrest
KW - Prognosis
KW - coma
KW - heart arrest
UR - http://hdl.handle.net/10807/60847
U2 - 10.1007/s00134-014-3470-x
DO - 10.1007/s00134-014-3470-x
M3 - Article
SN - 1432-1238
VL - 40
SP - 1816
EP - 1831
JO - Intensive Care Medicine
JF - Intensive Care Medicine
ER -