Prognostication in comatose survivors of cardiac arrest: An advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine

被引:258
作者
Sandroni, Claudio [1 ]
Cariou, Alain [2 ]
Cavallaro, Fabio [1 ]
Cronberg, Tobias [3 ]
Friberg, Hans [4 ]
Hoedemaekers, Cornelia [5 ]
Horn, Janneke [6 ]
Nolan, Jerry P. [7 ]
Rossetti, Andrea O. [8 ,9 ]
Soar, Jasmeet [10 ]
机构
[1] Catholic Univ, Sch Med, Dept Anesthesiol & Intens Care, I-00168 Rome, Italy
[2] Paris Descartes Univ, Cochin Hosp, AP HP, Med ICU, Paris, France
[3] Lund Univ, Dept Clin Sci, Div Neurol, Lund, Sweden
[4] Lund Univ, Skane Univ Hosp, Lund, Sweden
[5] Radboud Univ Nijmegen, Med Ctr, NL-6525 ED Nijmegen, Netherlands
[6] Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands
[7] Royal United Hosp, Dept Anaesthesia & Intens Care Med, Bath BA1 3NG, Avon, England
[8] Dept Clin Neurosci CHUV, Lausanne, Switzerland
[9] Univ Lausanne, CH-1015 Lausanne, Switzerland
[10] Southmead Hosp, Dept Anaesthesia & Intens Care Med, Bristol, Avon, England
基金
瑞士国家科学基金会;
关键词
NEURON-SPECIFIC ENOLASE; SOMATOSENSORY-EVOKED POTENTIALS; ANOXIC-ISCHEMIC ENCEPHALOPATHY; DIFFUSION-WEIGHTED MRI; BRAIN COMPUTED-TOMOGRAPHY; CRITICALLY-ILL PATIENTS; THERAPEUTIC HYPOTHERMIA; CARDIOPULMONARY-RESUSCITATION; MILD HYPOTHERMIA; SERUM-LEVELS;
D O I
10.1016/j.resuscitation.2014.08.011
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: To review and update the evidence on predictors of poor outcome (death, persistent vegetative state or severe neurological disability) in adult comatose survivors of cardiac arrest, either treated or not treated with controlled temperature, to identify knowledge gaps and to suggest a reliable prognostication strategy. Methods: GRADE-based systematic review followed by expert consensus achieved using Web-based Delphi methodology, conference calls and face-to-face meetings. Predictors based on clinical examination, electrophysiology, biomarkers and imaging were included. Results and conclusions: Evidence from a total of 73 studies was reviewed. The quality of evidence was low or very low for almost all studies. In patients who are comatose with absent or extensor motor response at >= 72 h from arrest, either treated or not treated with controlled temperature, bilateral absence of either pupillary and corneal reflexes or N20 wave of short-latency somatosensory evoked potentials were identified as the most robust predictors. Early status myoclonus, elevated values of neuron specific enolase at 48-72 h from arrest, unreactive malignant EEG patterns after rewarming, and presence of diffuse signs of postanoxic injury on either computed tomography or magnetic resonance imaging were identified as useful but less robust predictors. Prolonged observation and repeated assessments should be considered when results of initial assessment are inconclusive. Although no specific combination of predictors is sufficiently supported by available evidence, a multimodal prognostication approach is recommended in all patients. (C) 2014 The Authors. Published by Elsevier Ireland Ltd.
引用
收藏
页码:1779 / 1789
页数:11
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