Immediate prediction of recovery of consciousness after cardiac arrest

Nakabayashi, Motoaki; Kurokawa, Akira; Yamamoto, Yasuhiro

doi:10.1007/s001340100984

Cited by 44 publications

(21 citation statements)

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“…271,303,[320][321][322][323] For the critical outcome of survival with unfavorable neurologic status or death at 1 year, we identified 6 studies on SSEPs or EEG (829 patients; low-or very-low-quality evidence downgraded for serious or very serious bias and very serious imprecision). 306,307,[324][325][326][327] Short-Latency SSEPs. Bilateral absence of the N20 wave of short-latency SSEPs predicted death or vegetative state, with 0 (0-12)% FPR as early as 8 hours from cardiac arrest.…”

Section: Electrophysiologymentioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

557

125

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Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

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Section: Electrophysiologymentioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

557

125

View full text Add to dashboard Cite

show abstract

“…Consensus on Science Somatosensory evoked potentials measured between 4 hours and 2 weeks after cardiac arrest were associated with poor outcome in 14 studies (LOE P1 893,894,905,[941][942][943][944][945][946] ; LOE P2 897 ; LOE P3 936,[947][948][949] ). In a meta-analysis of patients not treated with therapeutic hypothermia, the absence of cortical N20 response to median nerve stimulation at 24 to 72 hours after cardiac arrest predicted poor outcome (CPC 3 or 4, or death) with a FPR of 0.7% (95% CI 0.1 to 3.7) (LOE P1).…”

Section: Als-pa-051amentioning

confidence: 99%

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

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“…Thirty-four patients (31%) regained consciousness, 5 of whom died in hospital after regaining consciousness. Thirty-one out of the 34 patients regaining consciousness 3 (3)(4)(5)(6)(7)(8)(9) did so within the first 48 h after CPR, 33 out of 34 within the first 72 h. Seventy-six patients (69%) did not regain consciousness, four of whom were discharged comatose, and the other 72 died in hospital. Sixty-seven of these 72 patients died within one week after admission.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…False positive test results for SSEP in the prediction of a poor outcome after CPR have only been reported when the test was done within the first 24 h after CPR [1,3]. Some authors, however, advocate the use of SSEP even in the first hours after CPR [4]. SSEP is not always available and the sensitivity of the test is low.…”

Section: Introductionmentioning

confidence: 98%