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

Bougouin, W; Lascarrou, JB; Chelly, J; Benghanem, S; Geri, G; Maizel, J; Fage, N; Sboui, G; Pichon, N; Daubin, C; Sauneuf, B; Mongardon, N; Taccone, F; Hermann, B; Colin, G; Lesieur, O; Deye, N; Chudeau, N; Cour, M; Bourenne, J; Klouche, K; Klein, T; Raphalen, JH; Muller, G; Galbois, A; Bruel, C; Jacquier, S; Paul, M; Sandroni, C; Cariou, A

doi:10.1016/j.resuscitation.2024.110362

Acute cardiac care & resuscitation

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

ResuscitationPublished 14 Aug 2024Prospective cohort study

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Authors' conclusion

All comatose resuscitated patients 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.

Study context

Population: OHCA survivors comatose (Glasgow Coma Scale motor score ≤3) at ≥72 h after resuscitation, 28 ICUs of the AfterROSC network
Participants: 337 participants

Exposure: 2021 ERC/ESICM neuroprognostication algorithm for predicting poor outcome after cardiac arrest (CA)
Combination of 2 favourable signsn = 162
Outcome: Accuracy for predicting poor outcome (modified Rankin scale score ≥4)
Follow-up: 90 days

Methodological detailsmulticentre, 28 ICUs

Multicentre
28 ICUs

Main finding

As reported in the abstract

Poor neurological outcome

Group	Value	PPV
ERC-ESICM algorithm	175 events	100% [98-100]%

ERC-ESICM algorithm

Value175 events

PPV100% [98-100]%

Specificity of individual predictors ranged from 90% for EEG to 100% for clinical examination and SSEP: 90%–100%

Observational data: associations, not effects.

Further findings

Outcome	ERC-ESICM algorithm	Combination of 2 favourable signs
Good outcome in patients with indeterminate outcome
Specificity	Not reported in the abstract	99[96-100]%	ERC-ESICM algorithm: not reported in the abstract
Sensitivity	Not reported in the abstract	23[11-38]%	ERC-ESICM algorithm: not reported in the abstract

Reference

Authors: Bougouin W, Lascarrou JB, Chelly J, Benghanem S, Geri G, Maizel J, et al.
All 30 authors
Bougouin W, Lascarrou JB, Chelly J, Benghanem S, Geri G, Maizel J, Fage N, Sboui G, Pichon N, Daubin C, Sauneuf B, Mongardon N, Taccone F, Hermann B, Colin G, Lesieur O, Deye N, Chudeau N, Cour M, Bourenne J, Klouche K, Klein T, Raphalen JH, Muller G, Galbois A, Bruel C, Jacquier S, Paul M, Sandroni C, Cariou A
Journal: Resuscitation
Published: 14 Aug 2024
DOI: 10.1016/j.resuscitation.2024.110362
PubMed: 39151721

Topic: Acute cardiac care & resuscitation

Exposure definitions

ERC-ESICM algorithm: neurological examination, NSE, EEG, SSEP, brain CT and MRI
Combination of 2 favourable signs: low or decreasing NSE levels and benign EEG, in patients with indeterminate outcome

Key notes

175 patients predicted poor outcome by algorithm

Original publication

Performance of the ERC/ESICM-recommendations for neuroprognostication after cardiac arrest: Insights from a prospective multicenter cohort. Resuscitation. Published 14 August 2024. doi:10.1016/j.resuscitation.2024.110362

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Summarised from the published abstract; every number is checked against it