ASSESSING UTILITY OF THE CURRENT NEUROPROGNOSTICATION MODALITIES FOR PREDICTING HYPOXIC BRAIN INJURY IN OUT OF HOSPITAL CARDIAC ARREST PATIENTS.

Hypoxic brain injury is inevitable in half of the out of hospital cardiac arrest patients. This has created an increased burden on the cardiac critical care unit to deliver high quality services with limited resources. The ESC/ESICM 2021 guidelines are implemented to neuro-prognosticate comatose patients as an appropriate timely decision-making endeavor. This quality improvement project aims to assess the predictability of a quadruped integrative tools for neuro-prognostication. An electronic record for 176 of total 193 out of hospital cardiac arrest patients was evaluated retrospectively. 16 patients were excluded due to missing or incomplete data and death on arrival. A neuro-prognostication score was calculated based on clinical examination, neurophysiology (Electroencephalogram and Somatosensory Evoked Potentials), Neuron-specific enolase biomarker and CT/MRI Head imaging. A Minitab statistical software was used for data analysis. The outcome was interpreted as Deaths due to primary hypoxic brain injury or withdrawal of life support treatment. Chi-square testing was used to evaluate the correlation between different diagnostic tests and outcome. Data collection has been ongoing since June 2021. Amongst 176 patients, 41.5% deaths with male predominance were observed. We confirmed the best predictors mentioned in guidelines had significant statistical influence for predicting poor outcome compatible with hypoxic neurological impairment. They are namely higher age, Miracle score >6, Initial rhythm as asystole or PEA, NPI less than 3, absent corneal or tracheal reflexes, myoclonus, abnormal EEG with burst suppression, highly malignant waves, status epilepticus, bilaterally absent SSEP N20 waves, loss of grey-white matter on CT head. Although gender and MRI had statistical insignificant correlation. This QI project also highlighted higher specificity (70-90%) in all eight prognostic tests but lower sensitivity (50-60%). The positive predictive value was highest for NPI, absence of corneal reflexes and abnormal CT head (85-100%). Only 13% of hypoxic brain injury patients had MRI as a second radiological test to conclude findings from the CT head in selected cases. 80% patients discharged from ICU had positive neurological outcomes with Cerebral performance category scale CPC 1-2. 92% of them were discharged home with an average LOS in hospital of 14 days. 10% of CPC 5 died for multifactorial reasons, 10% had CPC of 3 or 4 with average LOS of 52 days and 7% required repatriation to neurorehabilitation. Being able to make the right decision for all patient at the right time enhances best practice, allows for appropriate clinical decision and avoids prolonged ITU stay. So a robust, structured and multimodal neuroprognostication approach is necessary alongwith multidisciplinary meeting including intensivist, cardiologist, neurologist and radiologist. In each case, after 72 hours a neuroprognostication score was calculated based on the guidelines. Overall, all patients with more >2 markers of poor prognosis went for withdrawal of life sustaining therapy in their best interest. [ABSTRACT FROM AUTHOR]