External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

doi:10.1186/s13054-022-03954-w

. 2022 Apr 11;26(1):95.

doi: 10.1186/s13054-022-03954-w.

External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

Affiliations

¹ Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.
² Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea. emsky@catholic.ac.kr.
³ Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea. emsky@catholic.ac.kr.
⁴ Department of Emergency Medicine, Eunpyeong St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, 137-701, South Korea.
⁵ Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea.
⁶ Department of Clinical Sciences, Neurology, Skåne University Hospital, Lund University, Lund, Sweden.
⁷ Department of Emergency Medicine, Hanil General Hospital, Korea Electric Power Medical Corporation, Seoul, Korea.

PMID: 35399085
PMCID: PMC8996564
DOI: 10.1186/s13054-022-03954-w

External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

Chun Song Youn et al. Crit Care. 2022.

. 2022 Apr 11;26(1):95.

doi: 10.1186/s13054-022-03954-w.

Authors

Affiliations

¹ Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.
² Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea. emsky@catholic.ac.kr.
³ Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea. emsky@catholic.ac.kr.
⁴ Department of Emergency Medicine, Eunpyeong St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, 137-701, South Korea.
⁵ Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea.
⁶ Department of Clinical Sciences, Neurology, Skåne University Hospital, Lund University, Lund, Sweden.
⁷ Department of Emergency Medicine, Hanil General Hospital, Korea Electric Power Medical Corporation, Seoul, Korea.

PMID: 35399085
PMCID: PMC8996564
DOI: 10.1186/s13054-022-03954-w

Abstract

Purpose: To assess the performance of the post-cardiac arrest (CA) prognostication strategy algorithm recommended by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) in 2020.

Methods: This was a retrospective analysis of the Korean Hypothermia Network Prospective Registry 1.0. Unconscious patients without confounders at day 4 (72-96 h) after return of spontaneous circulation (ROSC) were included. The association between the prognostic factors included in the prognostication strategy algorithm, except status myoclonus and the neurological outcome, was investigated, and finally, the prognostic performance of the prognostication strategy algorithm was evaluated. Poor outcome was defined as cerebral performance categories 3-5 at 6 months after ROSC.

Results: A total of 660 patients were included in the final analysis. Of those, 108 (16.4%) patients had a good neurological outcome at 6 months after CA. The 2020 ERC/ESICM prognostication strategy algorithm identified patients with poor neurological outcome with 60.2% sensitivity (95% CI 55.9-64.4) and 100% specificity (95% CI 93.9-100) among patients who were unconscious or had a GCS_M score ≤ 3 and with 58.2% sensitivity (95% CI 53.9-62.3) and 100% specificity (95% CI 96.6-100) among unconscious patients. When two prognostic factors were combined, any combination of prognostic factors had a false positive rate (FPR) of 0 (95% CI 0-5.6 for combination of no PR/CR and poor CT, 0-30.8 for combination of No SSEP N20 and NSE 60).

Conclusion: The 2020 ERC/ESICM prognostication strategy algorithm predicted poor outcome without an FPR and with sensitivities of 58.2-60.2%. Any combinations of two predictors recommended by ERC/ESICM showed 0% of FPR.

Keywords: Cardiac arrest; Guideline algorithm; Outcome; Prognostic accuracy.

PubMed Disclaimer

Conflict of interest statement

None of the authors has declared a conflict of interest.

Figures

**Fig. 1**
Flow diagram of included patients. Unconscious patients ≥ 72 h after ROSC without confounders (N = 660) were defined as the first cohort to test the GCS_M score as one variable in the algorithm. Unconscious patients with a GCS_M score ≤ 3 at ≥ 72 h after ROSC without confounders (N = 589) were defined as the second cohort

**Fig. 2**
Prognostic performance of the 2020 ERC/ESICM prognostication strategy algorithm in cardiac arrest patients treated with targeted temperature management. A The 2020 ERC/ESICM prognostication strategy algorithm for the first cohort. The 2020 ERC/ESICM prognostication strategy algorithm predicted poor outcome without a false positive rate (FPR) and with sensitivities of 58.2%. B The 2020 ERC/ESICM prognostication strategy algorithm for the second cohort. The 2020 ERC/ESICM prognostication strategy algorithm predicted poor outcome without a false positive rate (FPR) and with sensitivities of 60.2%

See this image and copyright information in PMC

Cited by

Cortical somatosensory evoked potential amplitudes and clinical outcome after cardiac arrest: a retrospective multicenter study.
Aalberts N, Westhall E, Johnsen B, Hahn K, Kenda M, Cronberg T, Friberg H, Preuß S, Ploner CJ, Storm C, Nee J, Leithner C, Endisch C. Aalberts N, et al. J Neurol. 2023 Dec;270(12):5999-6009. doi: 10.1007/s00415-023-11951-4. Epub 2023 Aug 28. J Neurol. 2023. PMID: 37639017 Free PMC article.
Use of Prognostication Instruments in Prognostication Procedures of Postanoxic Coma Patients over Time: A Retrospective Study.
Daun C, Ebert A, Sandikci V, Britsch S, Szabo K, Alonso A. Daun C, et al. J Clin Med. 2023 May 9;12(10):3357. doi: 10.3390/jcm12103357. J Clin Med. 2023. PMID: 37240462 Free PMC article.
Quantitative analysis of apparent diffusion coefficients to predict neurological prognosis in cardiac arrest survivors: an observational derivation and internal-external validation study.
Yoon JA, Kang C, Park JS, You Y, Min JH, In YN, Jeong W, Ahn HJ, Jeong HS, Kim YH, Lee BK, Kim D. Yoon JA, et al. Crit Care. 2024 Apr 25;28(1):138. doi: 10.1186/s13054-024-04909-z. Crit Care. 2024. PMID: 38664807 Free PMC article.
Prognostic accuracy of head computed tomography for prediction of functional outcome after out-of-hospital cardiac arrest: Rationale and design of the prospective TTM2-CT-substudy.
Lang M, Leithner C, Scheel M, Kenda M, Cronberg T, During J, Rylander C, Annborn M, Dankiewicz J, Deye N, Halliday T, Lascarrou JB, Matthew T, McGuigan P, Morgan M, Thomas M, Ullén S, Undén J, Nielsen N, Moseby-Knappe M. Lang M, et al. Resusc Plus. 2022 Oct 12;12:100316. doi: 10.1016/j.resplu.2022.100316. eCollection 2022 Dec. Resusc Plus. 2022. PMID: 36267356 Free PMC article.
Quantitative pupillometry for neuroprognostication in comatose post-cardiac arrest patients: A protocol for a predefined sub-study of the Blood pressure and Oxygenations Targets after Out-of-Hospital Cardiac Arrest (BOX)-trial.
Nyholm B, Grand J, Obling LER, Hassager C, Møller JE, Schmidt H, Othman MH, Kondziella D, Kjaergaard J. Nyholm B, et al. Resusc Plus. 2023 Sep 26;16:100475. doi: 10.1016/j.resplu.2023.100475. eCollection 2023 Dec. Resusc Plus. 2023. PMID: 37779885 Free PMC article.

See all "Cited by" articles

References

1. Laver S, Farrow C, Turner D, Nolan J. Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med. 2004;30:2126–2128. doi: 10.1007/s00134-004-2425-z. - DOI - PubMed
1. Lemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche JD, Carli P, Mira JP, Nolan J, Cariou A. Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013;39:1972–1980. doi: 10.1007/s00134-013-3043-4. - DOI - PubMed
1. Hypothermia after Cardiac Arrest Study Group Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–556. doi: 10.1056/NEJMoa012689. - DOI - PubMed
1. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, et al. TTM Trial investigators. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369:2197–2206. doi: 10.1056/NEJMoa1310519. - DOI - PubMed
1. Lascarrou JB, Merdji H, Le Gouge A, Colin G, Grillet G, Girardie P, Coupez E, Dequin PF, Cariou A, Boulain T, et al. CRICS-TRIGGERSEP group. Targeted temperature management for cardiac arrest with nonshockable rhythm. N Engl J Med. 2019;381:2327–2337. doi: 10.1056/NEJMoa1906661. - DOI - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
Research Materials
- NCI CPTC Antibody Characterization Program

[1] Laver S, Farrow C, Turner D, Nolan J. Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med. 2004;30:2126–2128. doi: 10.1007/s00134-004-2425-z. - DOI - PubMed

[2] Laver S, Farrow C, Turner D, Nolan J. Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med. 2004;30:2126–2128. doi: 10.1007/s00134-004-2425-z. - DOI - PubMed

[3] Lemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche JD, Carli P, Mira JP, Nolan J, Cariou A. Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013;39:1972–1980. doi: 10.1007/s00134-013-3043-4. - DOI - PubMed

[4] Lemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche JD, Carli P, Mira JP, Nolan J, Cariou A. Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013;39:1972–1980. doi: 10.1007/s00134-013-3043-4. - DOI - PubMed

[5] Hypothermia after Cardiac Arrest Study Group Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–556. doi: 10.1056/NEJMoa012689. - DOI - PubMed

[6] Hypothermia after Cardiac Arrest Study Group Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–556. doi: 10.1056/NEJMoa012689. - DOI - PubMed

[7] Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, et al. TTM Trial investigators. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369:2197–2206. doi: 10.1056/NEJMoa1310519. - DOI - PubMed

[8] Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, et al. TTM Trial investigators. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369:2197–2206. doi: 10.1056/NEJMoa1310519. - DOI - PubMed

[9] Lascarrou JB, Merdji H, Le Gouge A, Colin G, Grillet G, Girardie P, Coupez E, Dequin PF, Cariou A, Boulain T, et al. CRICS-TRIGGERSEP group. Targeted temperature management for cardiac arrest with nonshockable rhythm. N Engl J Med. 2019;381:2327–2337. doi: 10.1056/NEJMoa1906661. - DOI - PubMed

[10] Lascarrou JB, Merdji H, Le Gouge A, Colin G, Grillet G, Girardie P, Coupez E, Dequin PF, Cariou A, Boulain T, et al. CRICS-TRIGGERSEP group. Targeted temperature management for cardiac arrest with nonshockable rhythm. N Engl J Med. 2019;381:2327–2337. doi: 10.1056/NEJMoa1906661. - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

Affiliations

External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

MeSH terms

Related information

LinkOut - more resources

Full Text Sources

Medical

Research Materials