Early Multimodal Outcome Prediction After Cardiac Arrest in Patients Treated With Hypothermia*

Abstract

Combination of clinical examination, electroencephalography reactivity, and serum neuron-specific enolase offers the best outcome predictive performance for prognostication of early postanoxic coma, whereas somatosensory-evoked potentials do not add any complementary information. Although prognostication of poor outcome seems excellent, future studies are needed to further improve prediction of good prognosis, which still remains inaccurate.

EEG for outcome prediction after cardiac arrest: when the quest for optimization needs standardization

“…Coming to clinical prognosticators, lack of corneal reflexes had the lowest false positive prediction of poor outcome (0 %); the false positive rate regarding occurrence of myoclonus was 14 %, especially if a normal voltage was observed, broadly confirming other recent observations [12,13]; false positivity for the lack motor response was identical, also in line with previous reports [12]. Finally, the authors propose a two-step approach for outcome prognosis, starting with EEG at 24 h and completing it with corneal reflexes at 72 h. This is a single-center analysis performed in an environment with the highest expertise for cEEG interpretation, potentially limiting its generalizability; the poor outcome rate of 71 % is higher than that in other recent series [5,12], but outcome assessment at discharge might have underestimated the recovery of some patients, especially for those in the inhomogeneous category of GOS (or CPC) = 3.…”

“…Finally, the authors propose a two-step approach for outcome prognosis, starting with EEG at 24 h and completing it with corneal reflexes at 72 h. This is a single-center analysis performed in an environment with the highest expertise for cEEG interpretation, potentially limiting its generalizability; the poor outcome rate of 71 % is higher than that in other recent series [5,12], but outcome assessment at discharge might have underestimated the recovery of some patients, especially for those in the inhomogeneous category of GOS (or CPC) = 3. Finally, it does not consider biochemical or somatosensory evoked potential (SSEP) variables.…”

“…For the time being, a multimodal approach including the maximum available data from different, potentially complementary sources (i.e., clinical, neurophysiologic, biochemical, and radiological) remains mandatory in order to minimize a potentially deleterious effect of the ominous ''self-fulfilling prophecy'' [1,2,12], which is always somewhat inherent to observational studies in this setting.…”

“…They reviewed all EEG recordings in the form of 5-min extracts taken at predefined intervals from the acute event (6,12,24,48, and 72 h). Blinded to patients' identity and outcome, they applied the recently published standardized American Clinical Neurophysiology Society (ACNS) critical care EEG terminology [4], correlating their data with those of other clinical investigations.…”

Combination of Initial Neurologic Examination, Quantitative Brain Imaging and Electroencephalography to Predict Outcome After Cardiac Arrest

“…[9][10][11][12][13][14][15][16][17][18] Recent work has tested predictive value of multiple modalities, but the ideal combination is not known. [28][29][30][31][32] Importantly, not all tests are necessary for all patients and some facilities may not offer all of these modalities. Some authors propose a stepwise approach to avoid premature WLST.…”