Early multimodal outcome prediction after cardiac arrest in patients treated with hypothermia.

Détails

ID Serval
serval:BIB_845A3623711B
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Early multimodal outcome prediction after cardiac arrest in patients treated with hypothermia.
Périodique
Critical Care Medicine
Auteur(s)
Oddo M., Rossetti A.O.
ISSN
1530-0293 (Electronic)
ISSN-L
0090-3493
Statut éditorial
Publié
Date de publication
2014
Volume
42
Numéro
6
Pages
1340-1347
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish PDF : Feature Articles
Résumé
OBJECTIVES: Therapeutic hypothermia and pharmacological sedation may influence outcome prediction after cardiac arrest. The use of a multimodal approach, including clinical examination, electroencephalography, somatosensory-evoked potentials, and serum neuron-specific enolase, is recommended; however, no study examined the comparative performance of these predictors or addressed their optimal combination.
DESIGN: Prospective cohort study.
SETTING: Adult ICU of an academic hospital.
PATIENTS: One hundred thirty-four consecutive adults treated with therapeutic hypothermia after cardiac arrest.
MEASUREMENTS AND MAIN RESULTS: Variables related to the cardiac arrest (cardiac rhythm, time to return of spontaneous circulation), clinical examination (brainstem reflexes and myoclonus), electroencephalography reactivity during therapeutic hypothermia, somatosensory-evoked potentials, and serum neuron-specific enolase. Models to predict clinical outcome at 3 months (assessed using the Cerebral Performance Categories: 5 = death; 3-5 = poor recovery) were evaluated using ordinal logistic regressions and receiving operator characteristic curves. Seventy-two patients (54%) had a poor outcome (of whom, 62 died), and 62 had a good outcome. Multivariable ordinal logistic regression identified absence of electroencephalography reactivity (p < 0.001), incomplete recovery of brainstem reflexes in normothermia (p = 0.013), and neuron-specific enolase higher than 33 μg/L (p = 0.029), but not somatosensory-evoked potentials, as independent predictors of poor outcome. The combination of clinical examination, electroencephalography reactivity, and neuron-specific enolase yielded the best predictive performance (receiving operator characteristic areas: 0.89 for mortality and 0.88 for poor outcome), with 100% positive predictive value. Addition of somatosensory-evoked potentials to this model did not improve prognostic accuracy.
CONCLUSIONS: Combination of clinical examination, electroencephalography reactivity, and serum neuron-specific enolase offers the best outcome predictive performance for prognostication of early postanoxic coma, whereas somatosensory-evoked potentials do not add any complementary information. Although prognostication of poor outcome seems excellent, future studies are needed to further improve prediction of good prognosis, which still remains inaccurate.
Pubmed
Web of science
Création de la notice
28/06/2014 16:03
Dernière modification de la notice
03/03/2018 18:54
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