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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 [...]

Purpose To assess the performance of a 4-step algorithm for neurological prognostication after cardiac arrest recommended by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM). Methods Retrospective descriptive analysis with data from the Target Temperature Management (TTM) Trial. Associations between predicted and actual neurological outcome were investigated for each step of the algorithm with results from clinical neurological examinations, neuroradiology (CT or MRI), neurophysiology (EEG and SSEP) and serum neuron-specific enolase. Patients examined with Glasgow Coma Scale Motor Score (GCS-M) on day 4 (72-96 h) post-arrest and available 6-month outcome were included. Poor outcome was defined as Cerebral Performance Category 3-5. Variations of the ERC/ESICM algorithm were explored within the same cohort. Results The ERC/ESICM algorithm identified poor outcome patients with 38.7% sensitivity (95% CI 33.1-44.7) and 100% specificity (95% CI 98.8-100) in a cohort of 585 patients. An alternative cut-off for serum neuron-specific enolase, an alternative EEG-classification and variations of the GCS-M had minor effects on the sensitivity without causing false positive predictions. The highest overall sensitivity, 42.5% (95% CI 36.7-48.5), was achieved when prognosticating patients irrespective of GCS-M score, with 100% specificity (95% CI 98.8-100) remaining. Conclusion The ERC/ESICM algorithm and all exploratory multimodal variations thereof investigated in this study predicted poor outcome without false positive predictions and with sensitivities 34.6-42.5%. Our results should be validated prospectively, preferably in patients where withdrawal of life-sustaining therapy is uncommon to exclude any confounding from self-fulfilling prophecies., Author(s): Marion Moseby-Knappe [sup.1], Erik Westhall [sup.2], Sofia Backman [sup.2], Niklas Mattsson-Carlgren [sup.1] [sup.3] [sup.4], Irina Dragancea [sup.1], Anna Lybeck [sup.5], Hans Friberg [sup.6], Pascal Stammet [sup.7], Gisela Lilja [sup.1], [...]

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 [...]

Purpose To evaluate the bispectral index (BIS) and suppression ratio (SR) as very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest. Methods Demographic data, BIS1, and SR1 were recorded from 97 patients after the first dose of neuromuscular blockade, with outcomes blinded, and compared to the discharge Cerebral Performance Category (CPC). Receiver-operator characteristic curves and a multiple logistic regression model were constructed to predict good (CPC 1-2, GO) and poor (CPC 3-5, PO) neurological outcomes. Results Fourteen patients were excluded from the final analysis; 33 of the remaining 83 patients (40%) were classified as GO. The BIS1 was higher in patients with GO (37 [28-40] vs. 7 [3-15], p < 0.001). BIS1 < 22 predicted PO with a likelihood ratio (LR) of 14.2 and an area under the curve (AUC) of 0.91 (95% CI 0.85-0.98, p < 0.001). SR1 [greater than or equal to]48 predicted PO with a LR of 12.7 and an AUC of 0.90 (95% CI 0.83-0.98, p < 0.001). Both BIS1 ([DELTA]AUC 0.16, p = 0.006) and SR1 ([DELTA]AUC 0.16, p = 0.005) predicted outcomes better than the time to return of spontaneous circulation. Conclusions In our single-center cohort utilizing moderate sedation, the bispectral index and suppression ratio recorded after the first dose of intermittent neuromuscular blockade were accurate and very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest., Author(s): David B. Seder [sup.1], Gilles L. Fraser [sup.1], Tracy Robbins [sup.1], Laurel Libby [sup.1], Richard R. Riker [sup.1] Author Affiliations: (1) grid.240160.1, Neuroscience Institute, Maine Medical Center, , 22 [...]

A study was conducted to evaluate whether intravenous drug administration in advanced cardiac life support (ACLS) would help improve the survival rate for out-of-hospital cardiac arrest. Results indicated that patients who received such intravenous administration had higher rates of short-term survival, but no significant differences in long-term survival and quality of CPR.

The article discusses the positive effects of hypothermia on mortality and morbidity and neurologic prognosis following cardiac arrest. The prognostic guidelines developed by the American Academy of Neurology come in handy in cases where no definite prognosis can be made following cardiac arrest or hypothermia.

Byline: Claudio Sandroni (1), Jerry Nolan (2), Fabio Cavallaro (1), Massimo Antonelli (1) Keywords: Cardiac arrest; Heart arrest; Cardiopulmonary resuscitation; Advanced cardiac life support; Sudden cardiac death Abstract: Design Review. Objective Medical literature on in-hospital cardiac arrest (IHCA) was reviewed to summarise: (a) the incidence of and survival after IHCA, (b) major prognostic factors, (c) possible interventions to improve survival. Results and conclusions The incidence of IHCA is rarely reported in the literature. Values range between 1 and 5 events per 1,000 hospital admissions, or 0.175 events/bed annually. Reported survival to hospital discharge varies from 0% to 42%, the most common range being between 15% and 20%. Pre-arrest prognostic factors: the prognostic value of age is controversial. Among comorbidities, sepsis, cancer, renal failure and homebound lifestyle are significantly associated with poor survival. However, pre-arrest morbidity scores have not yet been prospectively validated as instruments to predict failure to survive after IHCA. Intra-arrest factors: ventricular fibrillation/ventricular tachycardia (VF/VT) as the first recorded rhythm and a shorter interval between IHCA and cardiopulmonary resuscitation or defibrillation are associated with higher survival. However, VF/VT is present in only 25--35% of IHCAs. Short-term survival is also higher in patients resuscitated with chest compression rates above 80/min. Interventions likely to improve survival include: early recognition and stabilisation of patients at risk of IHCA to enable prevention, faster and better in-hospital resuscitation and early defibrillation. Mild therapeutic hypothermia is effective as post-arrest treatment of out-of-hospital cardiac arrest due to VF/VT, but its benefit after IHCA and after cardiac arrest with non-VF/VT rhythms has not been clearly demonstrated. Author Affiliation: (1) Intensive Care Unit, Catholic University School of Medicine, Rome, Italy (2) Intensive Care Unit, Royal United Hospital, Bath, UK Article History: Registration Date: 21/07/2006 Received Date: 02/02/2006 Accepted Date: 20/07/2006 Online Date: 22/09/2006

People who have a cardiac arrest and are defibrillated quickly by police, firefighters, or paramedics have a good prognosis, according to a study of 200 patients in Olmsted County, Minnesota. The city of Rochester in Olmsted County implemented early defibrillation by police in the late 1990s. Five years after their treatment, 79% of these patients were still alive and most had a nearly normal quality of life.