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Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature

Kamps, M. J. A. ; Horn, J. ; Oddo, M. ; Fugate, J. E. ; Storm, C. ; Cronberg, Tobias LU ; Wijman, C. A. ; Wu, O. ; Binnekade, J. M. and Hoedemaekers, C. W. E. (2013) In Intensive Care Medicine 39(10). p.1671-1682
Abstract
To assess the sensitivity and false positive rate (FPR) of neurological examination and somatosensory evoked potentials (SSEPs) to predict poor outcome in adult patients treated with therapeutic hypothermia after cardiopulmonary resuscitation (CPR). MEDLINE and EMBASE were searched for cohort studies describing the association of clinical neurological examination or SSEPs after return of spontaneous circulation with neurological outcome. Poor outcome was defined as severe disability, vegetative state and death. Sensitivity and FPR were determined. A total of 1,153 patients from ten studies were included. The FPR of a bilaterally absent cortical N20 response of the SSEP could be calculated from nine studies including 492 patients. The SSEP... (More)
To assess the sensitivity and false positive rate (FPR) of neurological examination and somatosensory evoked potentials (SSEPs) to predict poor outcome in adult patients treated with therapeutic hypothermia after cardiopulmonary resuscitation (CPR). MEDLINE and EMBASE were searched for cohort studies describing the association of clinical neurological examination or SSEPs after return of spontaneous circulation with neurological outcome. Poor outcome was defined as severe disability, vegetative state and death. Sensitivity and FPR were determined. A total of 1,153 patients from ten studies were included. The FPR of a bilaterally absent cortical N20 response of the SSEP could be calculated from nine studies including 492 patients. The SSEP had an FPR of 0.007 (confidence interval, CI, 0.001-0.047) to predict poor outcome. The Glasgow coma score (GCS) motor response was assessed in 811 patients from nine studies. A GCS motor score of 1-2 at 72 h had a high FPR of 0.21 (CI 0.08-0.43). Corneal reflex and pupillary reactivity at 72 h after the arrest were available in 429 and 566 patients, respectively. Bilaterally absent corneal reflexes had an FPR of 0.02 (CI 0.002-0.13). Bilaterally absent pupillary reflexes had an FPR of 0.004 (CI 0.001-0.03). At 72 h after the arrest the motor response to painful stimuli and the corneal reflexes are not a reliable tool for the early prediction of poor outcome in patients treated with hypothermia. The reliability of the pupillary response to light and the SSEP is comparable to that in patients not treated with hypothermia. (Less)
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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Prognostication, SSEP, Therapeutic hypothermia
in
Intensive Care Medicine
volume
39
issue
10
pages
1671 - 1682
publisher
Springer
external identifiers
  • wos:000324233200001
  • scopus:84884595032
  • pmid:23801384
ISSN
0342-4642
DOI
10.1007/s00134-013-3004-y
language
English
LU publication?
yes
id
dcfeb07d-8e91-494f-b3b4-803f700605a9 (old id 4102081)
date added to LUP
2016-04-01 09:51:47
date last changed
2022-04-19 20:13:50
@article{dcfeb07d-8e91-494f-b3b4-803f700605a9,
  abstract     = {{To assess the sensitivity and false positive rate (FPR) of neurological examination and somatosensory evoked potentials (SSEPs) to predict poor outcome in adult patients treated with therapeutic hypothermia after cardiopulmonary resuscitation (CPR). MEDLINE and EMBASE were searched for cohort studies describing the association of clinical neurological examination or SSEPs after return of spontaneous circulation with neurological outcome. Poor outcome was defined as severe disability, vegetative state and death. Sensitivity and FPR were determined. A total of 1,153 patients from ten studies were included. The FPR of a bilaterally absent cortical N20 response of the SSEP could be calculated from nine studies including 492 patients. The SSEP had an FPR of 0.007 (confidence interval, CI, 0.001-0.047) to predict poor outcome. The Glasgow coma score (GCS) motor response was assessed in 811 patients from nine studies. A GCS motor score of 1-2 at 72 h had a high FPR of 0.21 (CI 0.08-0.43). Corneal reflex and pupillary reactivity at 72 h after the arrest were available in 429 and 566 patients, respectively. Bilaterally absent corneal reflexes had an FPR of 0.02 (CI 0.002-0.13). Bilaterally absent pupillary reflexes had an FPR of 0.004 (CI 0.001-0.03). At 72 h after the arrest the motor response to painful stimuli and the corneal reflexes are not a reliable tool for the early prediction of poor outcome in patients treated with hypothermia. The reliability of the pupillary response to light and the SSEP is comparable to that in patients not treated with hypothermia.}},
  author       = {{Kamps, M. J. A. and Horn, J. and Oddo, M. and Fugate, J. E. and Storm, C. and Cronberg, Tobias and Wijman, C. A. and Wu, O. and Binnekade, J. M. and Hoedemaekers, C. W. E.}},
  issn         = {{0342-4642}},
  keywords     = {{Cardiac arrest; Prognostication; SSEP; Therapeutic hypothermia}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1671--1682}},
  publisher    = {{Springer}},
  series       = {{Intensive Care Medicine}},
  title        = {{Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature}},
  url          = {{http://dx.doi.org/10.1007/s00134-013-3004-y}},
  doi          = {{10.1007/s00134-013-3004-y}},
  volume       = {{39}},
  year         = {{2013}},
}