Validation of the 2021 ERC/ESICM guidelines for prediction of functional outcome after cardiac arrest
Lagebrant, Alice LU
(2023)
European Society of Intensive Care Medicine LIVES 2023: 36th Annual Congress Milan
In Intensive Care Medicine Experimental
11(Suppl 1).
p.555-555
- Abstract
- Introduction
About two thirds of in-hospital deaths following successful resuscitation after
cardiac arrest are due to hypoxic-ischaemic brain injury. (1,2) Most occur after a
decision to withdraw from life sustaining therapy (WLST) in patients where
meaningful neurological recovery is unlikely. (2) In 2021 the European
Resuscitation Council (ERC) and the European Society of Intensive Care Medicine
(ESICM) published a simplified guideline algorithm for prediction of neurological
outcome after cardiac arrest, broadening the screening criteria to also include
flexion posture.(3) External validations on its prognostic accuracy have previously
reported 53-60% sensitivity with 100%... (More) - Introduction
About two thirds of in-hospital deaths following successful resuscitation after
cardiac arrest are due to hypoxic-ischaemic brain injury. (1,2) Most occur after a
decision to withdraw from life sustaining therapy (WLST) in patients where
meaningful neurological recovery is unlikely. (2) In 2021 the European
Resuscitation Council (ERC) and the European Society of Intensive Care Medicine
(ESICM) published a simplified guideline algorithm for prediction of neurological
outcome after cardiac arrest, broadening the screening criteria to also include
flexion posture.(3) External validations on its prognostic accuracy have previously
reported 53-60% sensitivity with 100% specificity.(4,5)
Objectives
This study aims to validate the ERC/ESICM 2021 guidelines on neurological
prognostication after cardiac arrest in a large international multicenter population.
(3)
Methods
Retrospective descriptive analysis of the Targeted Hypothermia versus Targeted
Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial data. Patients with
available motor score on day 4 and neurological outcome at 6 months were
included.(6) The prognostic accuracy of ERC/ESICM 2021 algorithm, including
clinical examinations (pupillary and corneal reflexes ≥ 72 hours (h), early status
myoclonus ≤ 72 h), neurophysiological tests (EEG > 24 h, SSEP ≥ 24 h),
neuroimaging (CT ≤ 72 h, MRI 2-7 days) and biomarkers (serum neuron-specific
enolase (NSE) at 48 and/or 72 h), was assessed.
Results
A total of 1324 patients met the inclusion criteria, of which 753 (57%) were
eligible for neurological prognostication according to the screening criteria (Tab.1.,
Fig.1). Preliminary results indicate that the ERC/ESICM algorithm correctly
identified 258 patients with poor neurological outcome and 213 of the total 491
patients not fulfilling the guideline criteria had a good outcome. The overall
sensitivity for the algorithm was 48% (95% CI: 44-52%). Four cases of false
positive predictions were identified, yielding a specificity of 98% (95% CI: 95-
99%). Further results will be presented at the conference.
Conclusions
This validation study is the first to report a non-perfect specificity for the
ERC/ESICM 2021 guidelines on neurological prognostication after cardiac arrest.
The individual reports of false positive predictions and the potential interference
with sedation must be further evaluated to assure validity in prognostication and
avoid patients unrightfully being put at risk of WLST in clinical practice. Increasing
the number of patients correctly identified with poor neurological outcome while
assuring a 100% specificity remains the goal for further development of guidelines.
Limitations in this study include bias due to allowance of WLST during trial,
possible residual effects of sedation and that the analysis was performed on
reported examination results. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/40204244-03f2-427f-b346-82d2e20686c0
- author
- Lagebrant, Alice
LU
- author collaboration
- organization
- publishing date
- 2023-10-24
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Intensive Care Medicine Experimental
- volume
- 11
- issue
- Suppl 1
- article number
- 001196
- pages
- 555 - 555
- publisher
- Springer
- conference name
- European Society of Intensive Care Medicine LIVES 2023: 36th Annual Congress Milan
- conference location
- Milan, Italy
- conference dates
- 2023-10-23 - 2023-10-25
- ISSN
- 2197-425X
- language
- English
- LU publication?
- yes
- id
- 40204244-03f2-427f-b346-82d2e20686c0
- alternative location
- https://icm-experimental.springeropen.com/articles/supplements/volume-11-supplement-1
- date added to LUP
- 2024-09-21 05:12:29
- date last changed
- 2024-09-23 08:45:37
@misc{40204244-03f2-427f-b346-82d2e20686c0,
abstract = {{Introduction<br/>About two thirds of in-hospital deaths following successful resuscitation after<br/>cardiac arrest are due to hypoxic-ischaemic brain injury. (1,2) Most occur after a<br/>decision to withdraw from life sustaining therapy (WLST) in patients where<br/>meaningful neurological recovery is unlikely. (2) In 2021 the European<br/>Resuscitation Council (ERC) and the European Society of Intensive Care Medicine<br/>(ESICM) published a simplified guideline algorithm for prediction of neurological<br/>outcome after cardiac arrest, broadening the screening criteria to also include<br/>flexion posture.(3) External validations on its prognostic accuracy have previously<br/>reported 53-60% sensitivity with 100% specificity.(4,5)<br/><br/>Objectives<br/>This study aims to validate the ERC/ESICM 2021 guidelines on neurological<br/>prognostication after cardiac arrest in a large international multicenter population.<br/>(3)<br/><br/>Methods<br/>Retrospective descriptive analysis of the Targeted Hypothermia versus Targeted<br/>Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial data. Patients with<br/>available motor score on day 4 and neurological outcome at 6 months were<br/>included.(6) The prognostic accuracy of ERC/ESICM 2021 algorithm, including<br/>clinical examinations (pupillary and corneal reflexes ≥ 72 hours (h), early status<br/>myoclonus ≤ 72 h), neurophysiological tests (EEG > 24 h, SSEP ≥ 24 h),<br/>neuroimaging (CT ≤ 72 h, MRI 2-7 days) and biomarkers (serum neuron-specific<br/>enolase (NSE) at 48 and/or 72 h), was assessed.<br/><br/>Results<br/>A total of 1324 patients met the inclusion criteria, of which 753 (57%) were<br/>eligible for neurological prognostication according to the screening criteria (Tab.1.,<br/>Fig.1). Preliminary results indicate that the ERC/ESICM algorithm correctly<br/>identified 258 patients with poor neurological outcome and 213 of the total 491<br/>patients not fulfilling the guideline criteria had a good outcome. The overall<br/>sensitivity for the algorithm was 48% (95% CI: 44-52%). Four cases of false<br/>positive predictions were identified, yielding a specificity of 98% (95% CI: 95-<br/>99%). Further results will be presented at the conference.<br/><br/>Conclusions<br/>This validation study is the first to report a non-perfect specificity for the<br/>ERC/ESICM 2021 guidelines on neurological prognostication after cardiac arrest.<br/>The individual reports of false positive predictions and the potential interference<br/>with sedation must be further evaluated to assure validity in prognostication and<br/>avoid patients unrightfully being put at risk of WLST in clinical practice. Increasing<br/>the number of patients correctly identified with poor neurological outcome while<br/>assuring a 100% specificity remains the goal for further development of guidelines.<br/>Limitations in this study include bias due to allowance of WLST during trial,<br/>possible residual effects of sedation and that the analysis was performed on<br/>reported examination results.}},
author = {{Lagebrant, Alice}},
issn = {{2197-425X}},
language = {{eng}},
month = {{10}},
note = {{Conference Abstract}},
number = {{Suppl 1}},
pages = {{555--555}},
publisher = {{Springer}},
series = {{Intensive Care Medicine Experimental}},
title = {{Validation of the 2021 ERC/ESICM guidelines for prediction of functional outcome after cardiac arrest}},
url = {{https://icm-experimental.springeropen.com/articles/supplements/volume-11-supplement-1}},
volume = {{11}},
year = {{2023}},
}