Outcome prediction in comatose cardiac arrest patients with initial shockable and non‐shockable rhythms

• Published in: Acta anaesthesiologica Scandinavica 2024-02, Vol.68 (2), p.263-273
• Main Authors: Wimmer, Henning, Stensønes, Stine Håheim, Benth, Jūratė Šaltytė, Lundqvist, Christofer, Andersen, Geir Ø., Drægni, Tomas, Sunde, Kjetil, Nakstad, Espen Rostrup
• Format: Article
• Language: English
• Subjects: Accuracy; Anesthesia; Brain injury; Cardiac arrest; Cardiopulmonary Resuscitation; Coma; Coma - etiology; Cornea; Electroencephalography; Head injuries; Heart; Humans; hypoxic‐ischemic brain injury; late awakening; non‐shockable rhythm; Out-of-Hospital Cardiac Arrest - complications; Out-of-Hospital Cardiac Arrest - therapy; out‐of‐hospital cardiac arrest; Patients; Phosphopyruvate hydratase; Predictions; Prognosis; prognostication; Reflexes; Registries; resuscitation guidelines; Sensitivity; Somatosensory evoked potentials; withrawal of life sustaining therapy
• ISSN: 0001-5172; 1399-6576; 1399-6576
• DOI: 10.1111/aas.14337

Background Prognosis after out‐of‐hospital cardiac arrest (OHCA) is presumed poorer in patients with non‐shockable than shockable rhythms, frequently leading to treatment withdrawal. Multimodal outcome prediction is recommended 72 h post‐arrest in still comatose patients, not considering initial rhythms. We investigated accuracy of outcome predictors in all comatose OHCA survivors, with a particular focus on shockable vs. non‐shockable rhythms. Methods In this observational NORCAST sub‐study, patients still comatose 72 h post‐arrest were stratified by shockable vs. non‐shockable rhythms for outcome prediction analyzes. Good outcome was defined as cerebral performance category 1–2 within 6 months. False positive rate (FPR) was used for poor and sensitivity for good outcome prediction accuracy. Results Overall, 72/128 (56%) patients with shockable and 12/50 (24%) with non‐shockable rhythms had good outcome (p