Prognostic Role of Optic Nerve Sheath Diameter for Neurological Outcomes in Post‐Cardiac Arrest Patients: A Systematic Review and Meta‐Analysis

Abstract

Objective. The present study investigated whether optic nerve sheath diameter (ONSD) could be used to predict neurological outcomes in post-cardiac arrest (CA) patients. Methods. We performed a comprehensive literature search in the Cochrane Library, ScienceDirect, PubMed, and Web of Science from inception to June 2020 for eligible articles. Stata 14.0 software was used to calculate the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs), sensitivity, specificity, summary receiver operating characteristic (SROC) curve, subgroup analysis, sensitivity analysis, and publication bias. Results. Eight studies involving 473 patients were considered eligible for this meta-analysis. The pooled result using a random-effects model showed that broadened ONSD is associated with poor neurological outcomes in post-CA patients ( OR = 15.62 , 95% CI: 5.50–44.34, P < 0.001 ; I 2 = 58.4 %, P = 0.018 ), with a sensibility of 0.60 (95% CI: 0.45–0.73) and specificity of 0.94 (95% CI: 0.83–0.98). The area under the curve of the SROC curve for ONSD was 0.87 (95% CI: 0.84–0.90). Subgroup analysis revealed that sample size and time of ONSD measurement may be the source of heterogeneity. Sensitivity analysis demonstrated the stability of the results of this meta-analysis. No publication bias using Deeks’ funnel plot was noted across the studies ( P = 0.23 ). Conclusion. This meta-analysis confirmed that ONSD can be used to predict neurological outcomes in post-CA patients.

Optic Nerve Sheath Diameter for Predicting Outcomes in Post-Cardiac Arrest Syndrome: An Updated Systematic Review and Meta-Analysis

“…In the analysis of ONSD as a predictor of neurological outcomes, the overall ONSD was found to be higher in the PNO group than in the GNO group (SMD = 0.74; 95% CI = 0.22–1.27; I 2 = 87%). However, unlike previous systematic reviews that showed usefulness in predicting neurological prognosis of ONSD [ 7 , 8 ], it is difficult to determine whether an enlarged ONSD is useful for the prediction of neurological outcomes in PCAS. This is because after separating the neurological outcome by the measurement interval, we found that the results were different depending on the measurement time and that the low heterogeneity of outcomes (1 month and in-hospital mortality) was not feasible to draw a conclusion, owing to the lack of studies and low quality of evidence according to GRADE level.…”

“…Using ocular US and brain CT, two recent systematic reviews demonstrated that ONSD had a high diagnostic value for predicting poor neurological outcomes (PNO) in patients with PCAS [ 7 , 8 ]. In these reviews, ONSD showed low pooled sensitivity, high pooled specificity, and high area under the receiver-operating characteristic curve.…”

Predictive Utility of Changes in Optic Nerve Sheath Diameter after Cardiac Arrest for Neurologic Outcomes

“…Other studies have applied the ONSD in combination with other predictors, including GWR and albumin levels, to enhance the predictive value [ 13 , 19 , 21 ]. Moreover, two recent meta-analyses reported the potential use of the ONSD in predicting neurologic outcomes [ 19 , 20 ]. A registry-based multicenter study demonstrated inconsistency with these previous findings, as it reported no correlation between the ONSD on early unenhanced brain CT and neurologic outcomes in post-CA survivors managed with TTM administration [ 25 ].…”

“…Additionally, recent studies have demonstrated that the ONSD on brain CT is useful for early neurologic outcome prediction through the evaluation of increased ICP in patients with post-CA ROSC [14,18]. Two recent meta-analyses confirmed the utility of the ONSD as a prognostic factor for neurologic outcomes in post-CA patients [19,20]. However, the methodology of these systematic reviews and meta-analyses is concerning [19,20].…”

“…Two recent meta-analyses confirmed the utility of the ONSD as a prognostic factor for neurologic outcomes in post-CA patients [19,20]. However, the methodology of these systematic reviews and meta-analyses is concerning [19,20]. The definition of poor neurologic outcome (PNO) included both Glasgow-Pittsburgh Cerebral Performance Categories (CPCs) 5 and CPC 3-5, and the outcome measurement time had a wide range (from hospital discharge to 6 months post-discharge).…”