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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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.
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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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