Abstract：
OBJECTIVE: To assess the ability of clinical examination, biomarkers, electrophysiology and brain imaging, individually or in combination to predict good neurological outcomes at 6 months after CA.
METHODS: This was a retrospective analysis of the Korean Hypothermia Network Prospective Registry 1.0, which included adult out-of-hospital cardiac arrest (OHCA) patients (≥18 years). Good outcome predictors were defined as both pupillary light reflex (PLR) and corneal reflex (CR) at admission, Glasgow Coma Scale Motor score (GCS-M) >3 at admission, neuron-specific enolase (NSE) <17 µg/L at 24-72 h, a median nerve somatosensory evoked potential (SSEP) N20/P25 amplitude >4 µV, continuous background without discharges on electroencephalogram (EEG), and absence of anoxic injury on brain CT and diffusion-weighted imaging (DWI).
RESULTS: A total of 1327 subjects were included in the final analysis, and their median age was 59 years; among them, 412 subjects had a good neurological outcome at 6 months. GCS-M >3 at admission had the highest specificity of 96.7% (95% CI 95.3-97.8), and normal brain DWI had the highest sensitivity of 96.3% (95% CI 92.9-98.4). When the two predictors were combined, the sensitivities tended to decrease (ranging from 2.7-81.1%), and the specificities tended to increase, ranging from81.3-100%. Through the explorative variation of the 2021 European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) prognostication strategy algorithms, good outcomes were predicted, with a specificity of 83.2% and a sensitivity of 83.5% in patients by the algorithm.
CONCLUSIONS: Clinical examination, biomarker, electrophysiology, and brain imaging predicted good outcomes at 6 months after CA. When the two predictors were combined, the specificity further improved. With the 2021 ERC/ESICM guidelines, the number of indeterminate patients and the uncertainty of prognostication can be reduced by using a good outcome prediction algorithm.
METHODS: This was a retrospective analysis of the Korean Hypothermia Network Prospective Registry 1.0, which included adult out-of-hospital cardiac arrest (OHCA) patients (≥18 years). Good outcome predictors were defined as both pupillary light reflex (PLR) and corneal reflex (CR) at admission, Glasgow Coma Scale Motor score (GCS-M) >3 at admission, neuron-specific enolase (NSE) <17 µg/L at 24-72 h, a median nerve somatosensory evoked potential (SSEP) N20/P25 amplitude >4 µV, continuous background without discharges on electroencephalogram (EEG), and absence of anoxic injury on brain CT and diffusion-weighted imaging (DWI).
RESULTS: A total of 1327 subjects were included in the final analysis, and their median age was 59 years; among them, 412 subjects had a good neurological outcome at 6 months. GCS-M >3 at admission had the highest specificity of 96.7% (95% CI 95.3-97.8), and normal brain DWI had the highest sensitivity of 96.3% (95% CI 92.9-98.4). When the two predictors were combined, the sensitivities tended to decrease (ranging from 2.7-81.1%), and the specificities tended to increase, ranging from81.3-100%. Through the explorative variation of the 2021 European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) prognostication strategy algorithms, good outcomes were predicted, with a specificity of 83.2% and a sensitivity of 83.5% in patients by the algorithm.
CONCLUSIONS: Clinical examination, biomarker, electrophysiology, and brain imaging predicted good outcomes at 6 months after CA. When the two predictors were combined, the specificity further improved. With the 2021 ERC/ESICM guidelines, the number of indeterminate patients and the uncertainty of prognostication can be reduced by using a good outcome prediction algorithm.
摘要：
目的：评估临床检查的能力，生物标志物，电生理学和脑成像，单独或组合预测CA后6个月的良好神经系统预后。
方法：这是韩国低温网络前瞻性注册1.0的回顾性分析，其中包括成人院外心脏骤停（OHCA）患者（≥18岁）。良好的预后预测因子定义为入院时的瞳孔光反射（PLR）和角膜反射（CR）。入院时格拉斯哥昏迷评分（GCS-M）>3，神经元特异性烯醇化酶（NSE）在24-72小时<17µg/L，正中神经体感诱发电位（SSEP）N20/P25振幅>4µV，脑电图（EEG）上无放电的连续背景，脑CT和弥散加权成像（DWI）无缺氧损伤。
结果：最终分析共纳入1327名受试者，他们的平均年龄是59岁；其中，412名受试者在6个月时具有良好的神经结果。入院时GCS-M>3的特异性最高，为96.7%（95%CI95.3-97.8），正常脑DWI的敏感度最高,为96.3%(95%CI92.9-98.4)。当两个预测因子结合在一起时，敏感度呈下降趋势(范围为2.7-81.1%)，特异性趋于增加，范围从81.3-100%。通过2021年欧洲复苏委员会（ERC）和欧洲重症监护医学学会（ESICM）预测策略算法的探索性变化，预测了良好的结果，算法对患者的特异性为83.2%，灵敏度为83.5%。
结论：临床检查，生物标志物，电生理学,脑成像预测CA后6个月的良好结果。当两个预测因子结合在一起时，特异性进一步提高。根据2021年ERC/ESICM指南，使用良好的结果预测算法可以减少不确定患者的数量和预测的不确定性。
方法：这是韩国低温网络前瞻性注册1.0的回顾性分析，其中包括成人院外心脏骤停（OHCA）患者（≥18岁）。良好的预后预测因子定义为入院时的瞳孔光反射（PLR）和角膜反射（CR）。入院时格拉斯哥昏迷评分（GCS-M）>3，神经元特异性烯醇化酶（NSE）在24-72小时<17µg/L，正中神经体感诱发电位（SSEP）N20/P25振幅>4µV，脑电图（EEG）上无放电的连续背景，脑CT和弥散加权成像（DWI）无缺氧损伤。
结果：最终分析共纳入1327名受试者，他们的平均年龄是59岁；其中，412名受试者在6个月时具有良好的神经结果。入院时GCS-M>3的特异性最高，为96.7%（95%CI95.3-97.8），正常脑DWI的敏感度最高,为96.3%(95%CI92.9-98.4)。当两个预测因子结合在一起时，敏感度呈下降趋势(范围为2.7-81.1%)，特异性趋于增加，范围从81.3-100%。通过2021年欧洲复苏委员会（ERC）和欧洲重症监护医学学会（ESICM）预测策略算法的探索性变化，预测了良好的结果，算法对患者的特异性为83.2%，灵敏度为83.5%。
结论：临床检查，生物标志物，电生理学,脑成像预测CA后6个月的良好结果。当两个预测因子结合在一起时，特异性进一步提高。根据2021年ERC/ESICM指南，使用良好的结果预测算法可以减少不确定患者的数量和预测的不确定性。
