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Prognostication in comatose survivors of cardiac arrest: An advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine

Sandroni, Claudio; Cariou, Alain; Cavallaro, Fabio; Cronberg, Tobias LU ; Friberg, Hans LU ; Hoedemaekers, Cornelia; Horn, Janneke; Nolan, Jerry P.; Rossetti, Andrea O. and Soar, Jasmeet (2014) In Intensive Care Medicine 40(12). p.1816-1831
Abstract
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. 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. 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... (More)
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. 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. 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 a parts per thousand yen72 h from arrest, either treated or not treated with controlled temperature, bilateral absence of either pupillary and corneal reflexes or N20 wave of short-latency 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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Heart arrest, Coma, Prognosis, Clinical examination, Somatosensory, evoked potentials, Neuron specific enolase, CT scan, Magnetic resonance
in
Intensive Care Medicine
volume
40
issue
12
pages
1816 - 1831
publisher
Springer
external identifiers
  • wos:000345407500002
  • scopus:84918818793
ISSN
0342-4642
DOI
10.1007/s00134-014-3470-x
language
English
LU publication?
yes
id
f1432ccb-a863-4527-aa13-8b03aeee1477 (old id 4965934)
date added to LUP
2015-02-03 07:08:29
date last changed
2017-11-05 03:20:10
@article{f1432ccb-a863-4527-aa13-8b03aeee1477,
  abstract     = {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. 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. 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 a parts per thousand yen72 h from arrest, either treated or not treated with controlled temperature, bilateral absence of either pupillary and corneal reflexes or N20 wave of short-latency 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.},
  author       = {Sandroni, Claudio and Cariou, Alain and Cavallaro, Fabio and Cronberg, Tobias and Friberg, Hans and Hoedemaekers, Cornelia and Horn, Janneke and Nolan, Jerry P. and Rossetti, Andrea O. and Soar, Jasmeet},
  issn         = {0342-4642},
  keyword      = {Heart arrest,Coma,Prognosis,Clinical examination,Somatosensory,evoked potentials,Neuron specific enolase,CT scan,Magnetic resonance},
  language     = {eng},
  number       = {12},
  pages        = {1816--1831},
  publisher    = {Springer},
  series       = {Intensive Care Medicine},
  title        = {Prognostication in comatose survivors of cardiac arrest: An advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine},
  url          = {http://dx.doi.org/10.1007/s00134-014-3470-x},
  volume       = {40},
  year         = {2014},
}