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. 2022 Apr;48(4):389-413.
doi: 10.1007/s00134-022-06618-z. Epub 2022 Mar 4.

Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review

Claudio Sandroni  1   2 , Sonia D'Arrigo  3 , Sofia Cacciola  1 , Cornelia W E Hoedemaekers  4 , Erik Westhall  5 , Marlijn J A Kamps  6 , Fabio S Taccone  7 , Daniele Poole  8 , Frederick J A Meijer  9 , Massimo Antonelli  1   2 , Karen G Hirsch  10 , Jasmeet Soar  11 , Jerry P Nolan #  12 , Tobias Cronberg #  13
Affiliations

Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review

Claudio Sandroni et al. Intensive Care Med. 2022 Apr.

Abstract

Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict good neurological outcome, defined as no, mild, or moderate disability (CPC 1-2 or mRS 0-3) at discharge from intensive care unit or later, in comatose adult survivors from cardiac arrest (CA).

Methods: PubMed, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews were searched. Sensitivity and specificity for good outcome were calculated for each predictor. The risk of bias was assessed using the QUIPS tool.

Results: A total of 37 studies were included. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. A withdrawal or localisation motor response to pain immediately or at 72-96 h after ROSC, normal blood values of neuron-specific enolase (NSE) at 24 h-72 h after ROSC, a short-latency somatosensory evoked potentials (SSEPs) N20 wave amplitude > 4 µV or a continuous background without discharges on electroencephalogram (EEG) within 72 h from ROSC, and absent diffusion restriction in the cortex or deep grey matter on MRI on days 2-7 after ROSC predicted good neurological outcome with more than 80% specificity and a sensitivity above 40% in most studies. Most studies had moderate or high risk of bias.

Conclusions: In comatose cardiac arrest survivors, clinical, biomarker, electrophysiology, and imaging studies identified patients destined to a good neurological outcome with high specificity within the first week after cardiac arrest (CA).

Keywords: Cardiac arrest; Clinical examination; Coma; Computed tomography; Diffusion magnetic resonance imaging; Electroencephalogram; Neuron specific enolase; Prognosis; Somatosensory evoked potentials.

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Conflict of interest statement

CS is member of the Editorial Board of Intensive Care Medicine and co-author of studies included in the present review. MA has received research grants from GE and Estor, and honoraria for board participation from Toray, Pfizer and Intersurgical. None of these COIs are related to the topic of the present review. FST is Scientific Advisor for Neuroptics and Nihon Khoden. None of these COIs are related to the topic of the present review. He is also co-author of studies included in the present review. JS is an Editor of Resuscitation. JN is Editor-in-Chief of Resuscitation. TC, CWEH, and EW are co-authors of studies included in the present review. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart illustrating the process of selection of the studies
See this image and copyright information in PMC

References

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