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Prognostication in ...
Prognostication in comatose survivors of cardiac arrest: An advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine
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Sandroni, Claudio (author)
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Cariou, Alain (author)
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Cavallaro, Fabio (author)
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- Cronberg, Tobias (author)
- Lund University,Lunds universitet,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Department of Clinical Sciences, Lund,Faculty of Medicine
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- Friberg, Hans (author)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine
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Hoedemaekers, Cornelia (author)
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Horn, Janneke (author)
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Nolan, Jerry P. (author)
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Rossetti, Andrea O. (author)
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Soar, Jasmeet (author)
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(creator_code:org_t)
- 2014-11-15
- 2014
- English.
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In: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 40:12, s. 1816-1831
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Abstract
Subject headings
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- 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. 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. 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 a parts per thousand yen72 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Keyword
- Heart arrest
- Coma
- Prognosis
- Clinical examination
- Somatosensory
- evoked potentials
- Neuron specific enolase
- CT scan
- Magnetic resonance
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Sandroni, Claudi ...
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Cariou, Alain
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Cavallaro, Fabio
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Cronberg, Tobias
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Friberg, Hans
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Hoedemaekers, Co ...
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show more...
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Horn, Janneke
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Nolan, Jerry P.
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Rossetti, Andrea ...
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Soar, Jasmeet
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Anesthesiology a ...
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Intensive Care M ...
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Lund University