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Purpose To assess the ability of clinical examination, blood biomarkers, electrophysiology or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict good neurological outcome, defined as no, mild, or moderate disability (CPC 1-2 or mRS 0-3) at discharge from intensive care unit or later, in comatose adult survivors from cardiac arrest (CA). Methods PubMed, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews were searched. Sensitivity and specificity for good outcome were calculated for each predictor. The risk of bias was assessed using the QUIPS tool. Results A total of 37 studies were included. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. A withdrawal or localisation motor response to pain immediately or at 72-96 h after ROSC, normal blood values of neuron-specific enolase (NSE) at 24 h-72 h after ROSC, a short-latency somatosensory evoked potentials (SSEPs) N20 wave amplitude > 4 [micro]V or a continuous background without discharges on electroencephalogram (EEG) within 72 h from ROSC, and absent diffusion restriction in the cortex or deep grey matter on MRI on days 2-7 after ROSC predicted good neurological outcome with more than 80% specificity and a sensitivity above 40% in most studies. Most studies had moderate or high risk of bias. Conclusions In comatose cardiac arrest survivors, clinical, biomarker, electrophysiology, and imaging studies identified patients destined to a good neurological outcome with high specificity within the first week after cardiac arrest (CA)., Author(s): Claudio Sandroni [sup.1] [sup.2], Sonia D'Arrigo [sup.1], Sofia Cacciola [sup.1], Cornelia W. E. Hoedemaekers [sup.3], Erik Westhall [sup.4], Marlijn J. A. Kamps [sup.5], Fabio S. Taccone [sup.6], Daniele Poole [...]

Post-cardiac arrest brain injury (PCABI) is caused by initial ischaemia and subsequent reperfusion of the brain following resuscitation. In those who are admitted to intensive care unit after cardiac arrest, PCABI manifests as coma, and is the main cause of mortality and long-term disability. This review describes the mechanisms of PCABI, its treatment options, its outcomes, and the suggested strategies for outcome prediction., Author(s): Claudio Sandroni [sup.1] [sup.2], Tobias Cronberg [sup.3], Mypinder Sekhon [sup.4] Author Affiliations: (1) grid.8142.f, 0000 0001 0941 3192, Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro [...]

Purpose The majority of unconscious patients after cardiac arrest (CA) do not fulfill guideline criteria for a likely poor outcome, their prognosis is considered 'indeterminate'. We compared brain injury markers in blood for prediction of good outcome and for identifying false positive predictions of poor outcome as recommended by guidelines. Methods Retrospective analysis of prospectively collected serum samples at 24, 48 and 72 h post arrest within the Target Temperature Management after out-of-hospital cardiac arrest (TTM)-trial. Clinically available markers neuron-specific enolase (NSE) and S100B, and novel markers neurofilament light chain (NFL), total tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) were analysed. Normal levels with a priori cutoffs specified by reference laboratories or defined from literature were used to predict good outcome (no to moderate disability, Cerebral Performance Category scale 1-2) at 6 months. Results Seven hundred and seventeen patients were included. Normal NFL, tau and GFAP had the highest sensitivities (97.2-98% of poor outcome patients had abnormal serum levels) and NPV (normal levels predicted good outcome in 87-95% of patients). Normal S100B and NSE predicted good outcome with NPV 76-82.2%. Normal NSE correctly identified 67/190 (35.3%) patients with good outcome among those classified as 'indeterminate outcome' by guidelines. Five patients with single pathological prognostic findings despite normal biomarkers had good outcome. Conclusion Low levels of brain injury markers in blood are associated with good neurological outcome after CA. Incorporating biomarkers into neuroprognostication may help prevent premature withdrawal of life-sustaining therapy., Author(s): Marion Moseby-Knappe [sup.1], Niklas Mattsson-Carlgren [sup.1] [sup.2] [sup.3], Pascal Stammet [sup.4], Sofia Backman [sup.5], Kaj Blennow [sup.6] [sup.7], Josef Dankiewicz [sup.8], Hans Friberg [sup.9], Christian Hassager [sup.10] [sup.11], Janneke [...]

Author(s): Lorenzo Peluso [sup.1] , Mauro Oddo [sup.2] , Claudio Sandroni [sup.3] [sup.4] , Giuseppe Citerio [sup.5] [sup.6] , Fabio Silvio Taccone [sup.1] Author Affiliations: (1) grid.4989.c, 0000 0001 2348 [...]