Performance of the ERC/ESICM-recommendations for neuroprognostication after cardiac arrest: insights from a prospective multicenter cohort - Centre hospitalier public du Cotentin
Article Dans Une Revue Resuscitation Année : 2024

Performance of the ERC/ESICM-recommendations for neuroprognostication after cardiac arrest: insights from a prospective multicenter cohort

1 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
2 Hôpital Privé Jacques Cartier [Massy]
3 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
4 MIP - Motricité, interactions, performance UR 4334 / Movement - Interactions - Performance
5 Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse
6 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
7 Hôpital Ambroise Paré [AP-HP]
8 CHU Amiens-Picardie
9 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires - UR UPJV 7517
10 MITOVASC - MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale
11 CHU Angers - Centre Hospitalier Universitaire d'Angers
12 AfterROSC - After ROSC research network [Paris, France]
13 CH Brive - Centre Hospitalier de Brive-la-Gaillarde
14 Service de Soins Intensifs [CHU Caen]
15 CHPC - CH Centre Hospitalier Public du Cotentin
16 IMRB - Institut Mondor de Recherche Biomédicale
17 ULB - Université libre de Bruxelles
18 HEGP - Hôpital Européen Georges Pompidou [APHP]
19 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
20 Hôpitaux La Rochelle Ré Aunis [Groupe hospitalier littoral Atlantique]
21 Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière]
22 Centre Hospitalier Le Mans (CH Le Mans)
23 Hôpital Edouard Herriot [CHU - HCL]
24 UCBL - Université Claude Bernard Lyon 1
25 TIMONE - Hôpital de la Timone [CHU - APHM]
26 AMU - Aix Marseille Université
Ghada Sboui
  • Fonction : Auteur
Kada Klouche
  • Fonction : Auteur
Thomas Klein
  • Fonction : Auteur
Jean-Herlé Raphalen
  • Fonction : Auteur
Grégoire Muller
  • Fonction : Auteur
Arnaud Galbois
  • Fonction : Auteur
Cédric Bruel
  • Fonction : Auteur
Sophie Jacquier
  • Fonction : Auteur
Marine Paul
  • Fonction : Auteur
Claudio Sandroni
  • Fonction : Auteur
Alain Cariou
  • Fonction : Auteur

Résumé

Brief abstract: In a multicentre network of 28 ICUs in France and Belgium, all comatose patients who fulfilled the 2021 ERC-ESICM criteria for poor outcome after cardiac arrest died or survived with severe neurological disability, even after excluding patients with active WLST to limit self-fulfilling prophecy bias. However, in almost half of the patients, these criteria were not fulfilled, resulting in an indeterminate outcome; in these patients, normal NSE levels and benign EEG predicted neurological recovery, helping reduce prognostic uncertainty. Aim To investigate the performance of the 2021 ERC/ESICM-recommended algorithm for predicting poor outcome after cardiac arrest (CA) and potential tools for predicting neurological recovery in patients with indeterminate outcome. Methods Prospective, multicenter study on out-of-hospital CA survivors from 28 ICUs of the AfterROSC network. In patients comatose with a Glasgow Coma Scale motor score ≤3 at ≥72 hours after resuscitation, we measured: 1) the accuracy of neurological examination, biomarkers (neuron-specific enolase, NSE), electrophysiology (EEG and SSEP) and neuroimaging (brain CT and MRI) for predicting poor outcome (modified Rankin scale score≥4 at 90 days), and 2) the ability of low or decreasing NSE levels and benign EEG to predict good outcome in patients whose prognosis remained indeterminate. Results Among 337 included patients, the ERC-ESICM algorithm predicted poor neurological outcome in 175 patients, of whom 106 (60%) had withdrawal of life-sustaining treatment (WLST). Among the 69 patients without active WLST, the positive predictive value for an unfavourable outcome was 100% [95-100]%. The specificity of individual predictors ranged from 90% for EEG to 100% for clinical examination and SSEP. Among the remaining 162 patients with indeterminate outcome, a combination of 2 favourable signs predicted good outcome with 99[96-100]% specificity and 23[11-38%]% sensitivity. Conclusion All comatose resuscitated patients not undergoing WLST who fulfilled the ERC-ESICM criteria for poor outcome after CA had poor outcome at three months, even if a self-fulfilling prophecy cannot be completely excluded. In patients with indeterminate outcome (half of the population), favourable signs predicted neurological recovery, reducing prognostic uncertainty.
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Dates et versions

hal-04671787 , version 1 (26-09-2024)

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Citer

Wulfran Bougouin, Jean-Baptiste Lascarrou, Jonathan Chelly, Sarah Benghanem, Guillaume Geri, et al.. Performance of the ERC/ESICM-recommendations for neuroprognostication after cardiac arrest: insights from a prospective multicenter cohort. Resuscitation, 2024, pp.110362. ⟨10.1016/j.resuscitation.2024.110362⟩. ⟨hal-04671787⟩
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