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Multimodal Approach to Predict Neurological Outcome after Cardiac Arrest: A Single-Center Experience
Introduction: The aims of this study were to assess the concordance of different tools and to describe the accuracy of a multimodal approach to predict unfavorable neurological outcome (UO) in cardiac arrest patients. Methods: Retrospective study of adult (>18 years) cardiac arrest patients who u...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8303816/ https://www.ncbi.nlm.nih.gov/pubmed/34356123 http://dx.doi.org/10.3390/brainsci11070888 |
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author | Peluso, Lorenzo Boisdenghien, Thomas Attanasio, Laila Annoni, Filippo Mateus Sanabria, Lili Severgnini, Paolo Legros, Benjamin Gouvêa Bogossian, Elisa Vincent, Jean-Louis Creteur, Jacques Oddo, Mauro Gaspard, Nicolas Taccone, Fabio Silvio |
author_facet | Peluso, Lorenzo Boisdenghien, Thomas Attanasio, Laila Annoni, Filippo Mateus Sanabria, Lili Severgnini, Paolo Legros, Benjamin Gouvêa Bogossian, Elisa Vincent, Jean-Louis Creteur, Jacques Oddo, Mauro Gaspard, Nicolas Taccone, Fabio Silvio |
author_sort | Peluso, Lorenzo |
collection | PubMed |
description | Introduction: The aims of this study were to assess the concordance of different tools and to describe the accuracy of a multimodal approach to predict unfavorable neurological outcome (UO) in cardiac arrest patients. Methods: Retrospective study of adult (>18 years) cardiac arrest patients who underwent multimodal monitoring; UO was defined as cerebral performance category 3–5 at 3 months. Predictors of UO were neurological pupillary index (NPi) ≤ 2 at 24 h; highly malignant patterns on EEG (HMp) within 48 h; bilateral absence of N20 waves on somato-sensory evoked potentials; and neuron-specific enolase (NSE) > 75 μg/L. Time-dependent decisional tree (i.e., NPi on day 1; HMp on day 1–2; absent N20 on day 2–3; highest NSE) and classification and regression tree (CART) analysis were used to assess the prediction of UO. Results: Of 137 patients, 104 (73%) had UO. Abnormal NPi, HMp on day 1 or 2, the bilateral absence of N20 or NSE >75 mcg/L had a specificity of 100% to predict UO. The presence of abnormal NPi was highly concordant with HMp and high NSE, and absence of N20 or high NSE with HMp. However, HMp had weak to moderate concordance with other predictors. The time-dependent decisional tree approach identified 73/103 patients (70%) with UO, showing a sensitivity of 71% and a specificity of 100%. Using the CART approach, HMp on EEG was the only variable significantly associated with UO. Conclusions: This study suggests that patients with UO had often at least two predictors of UO, except for HMp. A multimodal time-dependent approach may be helpful in the prediction of UO after CA. EEG should be included in all multimodal prognostic models. |
format | Online Article Text |
id | pubmed-8303816 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-83038162021-07-25 Multimodal Approach to Predict Neurological Outcome after Cardiac Arrest: A Single-Center Experience Peluso, Lorenzo Boisdenghien, Thomas Attanasio, Laila Annoni, Filippo Mateus Sanabria, Lili Severgnini, Paolo Legros, Benjamin Gouvêa Bogossian, Elisa Vincent, Jean-Louis Creteur, Jacques Oddo, Mauro Gaspard, Nicolas Taccone, Fabio Silvio Brain Sci Article Introduction: The aims of this study were to assess the concordance of different tools and to describe the accuracy of a multimodal approach to predict unfavorable neurological outcome (UO) in cardiac arrest patients. Methods: Retrospective study of adult (>18 years) cardiac arrest patients who underwent multimodal monitoring; UO was defined as cerebral performance category 3–5 at 3 months. Predictors of UO were neurological pupillary index (NPi) ≤ 2 at 24 h; highly malignant patterns on EEG (HMp) within 48 h; bilateral absence of N20 waves on somato-sensory evoked potentials; and neuron-specific enolase (NSE) > 75 μg/L. Time-dependent decisional tree (i.e., NPi on day 1; HMp on day 1–2; absent N20 on day 2–3; highest NSE) and classification and regression tree (CART) analysis were used to assess the prediction of UO. Results: Of 137 patients, 104 (73%) had UO. Abnormal NPi, HMp on day 1 or 2, the bilateral absence of N20 or NSE >75 mcg/L had a specificity of 100% to predict UO. The presence of abnormal NPi was highly concordant with HMp and high NSE, and absence of N20 or high NSE with HMp. However, HMp had weak to moderate concordance with other predictors. The time-dependent decisional tree approach identified 73/103 patients (70%) with UO, showing a sensitivity of 71% and a specificity of 100%. Using the CART approach, HMp on EEG was the only variable significantly associated with UO. Conclusions: This study suggests that patients with UO had often at least two predictors of UO, except for HMp. A multimodal time-dependent approach may be helpful in the prediction of UO after CA. EEG should be included in all multimodal prognostic models. MDPI 2021-07-01 /pmc/articles/PMC8303816/ /pubmed/34356123 http://dx.doi.org/10.3390/brainsci11070888 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Peluso, Lorenzo Boisdenghien, Thomas Attanasio, Laila Annoni, Filippo Mateus Sanabria, Lili Severgnini, Paolo Legros, Benjamin Gouvêa Bogossian, Elisa Vincent, Jean-Louis Creteur, Jacques Oddo, Mauro Gaspard, Nicolas Taccone, Fabio Silvio Multimodal Approach to Predict Neurological Outcome after Cardiac Arrest: A Single-Center Experience |
title | Multimodal Approach to Predict Neurological Outcome after Cardiac Arrest: A Single-Center Experience |
title_full | Multimodal Approach to Predict Neurological Outcome after Cardiac Arrest: A Single-Center Experience |
title_fullStr | Multimodal Approach to Predict Neurological Outcome after Cardiac Arrest: A Single-Center Experience |
title_full_unstemmed | Multimodal Approach to Predict Neurological Outcome after Cardiac Arrest: A Single-Center Experience |
title_short | Multimodal Approach to Predict Neurological Outcome after Cardiac Arrest: A Single-Center Experience |
title_sort | multimodal approach to predict neurological outcome after cardiac arrest: a single-center experience |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8303816/ https://www.ncbi.nlm.nih.gov/pubmed/34356123 http://dx.doi.org/10.3390/brainsci11070888 |
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