Preliminary Prognostication for Good Neurological Outcomes in the Early Stage of Post-Cardiac Arrest Care

We investigated prognostic strategies for predicting good outcomes in the early stage of post-cardiac-arrest care using multiple prognostic tests that are available until 24 h after the return of spontaneous circulation (ROSC). A retrospective analysis was conducted on 138 out-of-hospital cardiac-ar...

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Bibliographic Details
Published in:Diagnostics (Basel) 2023-06, Vol.13 (13), p.2174
Main Authors: Lee, Sunghyuk, Park, Jung Soo, You, Yeonho, Min, Jin Hong, Jeong, Wonjoon, Ahn, Hong Joon, In, Yong Nam, Cho, Yong Chul, Lee, In Ho, Lee, Jae Kwang, Kang, Changshin
Format: Article
Language:English
Subjects:
Analysis
Anesthesia
Biomarkers
Cardiac arrest
Cardiac patients
Cardiopulmonary resuscitation
clinical examination
Clinical outcomes
computed tomography
Convulsions & seizures
CPR
Extracorporeal membrane oxygenation
Intensive care
Laboratories
Levetiracetam
neuron specific enolase
out-of-hospital cardiac arrest
Prognosis
Statistical analysis
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Summary:We investigated prognostic strategies for predicting good outcomes in the early stage of post-cardiac-arrest care using multiple prognostic tests that are available until 24 h after the return of spontaneous circulation (ROSC). A retrospective analysis was conducted on 138 out-of-hospital cardiac-arrest patients who underwent prognostic tests, including the gray-white-matter ratio (GWR-BG), the Glasgow Coma Scale motor (GCS-M) score before sedative administration, and the neuron-specific enolase (NSE) level measured at 24 h after the ROSC. We investigated the prognostic performances of the tests as single predictors and in various combination strategies. Classification and regression-tree analysis were used to provide a reliable model for the risk stratification. Out of all the patients, 55 (44.0%) had good outcomes. The NSE level showed the highest prognostic performance as a single prognostic test and provided improved specificities (>70%) and sensitivities (>98%) when used in combination strategies. Low NSE levels (≤32.1 ng/mL) and high GCS-M (≥4) scores identified good outcomes without misclassification. The overall accuracy for good outcomes was 81.8%. In comatose patients with low NSE levels or high GCS-M scores, the premature withdrawal of life-sustaining therapy should be avoided, thereby complying with the formal prognostication-strategy algorithm after at least 72 h from the ROSC.
ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics13132174