评估由欧洲复苏委员会(ERC)和欧洲重症监护医学会(ESICM)推荐的心脏骤停后神经预测的4步算法的性能。
使用来自目标温度管理(TTM)试验的数据进行回顾性描述性分析。对于算法的每个步骤,研究了预测和实际神经系统结果与临床神经系统检查结果之间的关联。神经放射学(CT或MRI),神经生理学(EEG和SSEP)和血清神经元特异性烯醇化酶。包括在停药后第4天(72-96小时)接受格拉斯哥昏迷量表运动评分(GCS-M)检查的患者以及可获得的6个月结局。不良结果定义为3-5类脑功能。在同一队列中探索ERC/ESICM算法的变化。
在585例患者队列中,ERC/ESICM算法以38.7%的敏感性(95%CI33.1-44.7)和100%的特异性(95%CI98.8-100)识别出不良预后患者。血清神经元特异性烯醇化酶的替代截止值,另一种EEG分类和GCS-M变异对灵敏度影响较小,且不会导致假阳性预测.整体灵敏度最高,42.5%(95%CI36.7-48.5),在预测患者时,无论GCS-M评分如何,保持100%特异性(95%CI98.8-100)。
本研究中研究的ERC/ESICM算法及其所有探索性多模态变化预测了不良结果,没有假阳性预测,敏感性为34.6-42.5%。我们的结果应该得到前瞻性的验证,最好是在不经常退出维持生命治疗的患者中,以将任何混杂因素排除在自我实现的预言之外。
To assess the performance of a 4-step algorithm for neurological prognostication after cardiac arrest recommended by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM).
Retrospective descriptive analysis with data from the Target Temperature Management (TTM) Trial. Associations between predicted and actual neurological outcome were investigated for each step of the algorithm with results from clinical neurological examinations, neuroradiology (CT or MRI), neurophysiology (EEG and SSEP) and serum neuron-specific enolase. Patients examined with Glasgow Coma Scale Motor Score (GCS-M) on day 4 (72-96 h) post-arrest and available 6-month outcome were included. Poor outcome was defined as Cerebral Performance Category 3-5. Variations of the ERC/ESICM algorithm were explored within the same cohort.
The ERC/ESICM algorithm identified poor outcome patients with 38.7% sensitivity (95% CI 33.1-44.7) and 100% specificity (95% CI 98.8-100) in a cohort of 585 patients. An alternative cut-off for serum neuron-specific enolase, an alternative EEG-classification and variations of the GCS-M had minor effects on the sensitivity without causing false positive predictions. The highest overall sensitivity, 42.5% (95% CI 36.7-48.5), was achieved when prognosticating patients irrespective of GCS-M score, with 100% specificity (95% CI 98.8-100) remaining.
The ERC/ESICM algorithm and all exploratory multimodal variations thereof investigated in this study predicted poor outcome without false positive predictions and with sensitivities 34.6-42.5%. Our results should be validated prospectively, preferably in patients where withdrawal of life-sustaining therapy is uncommon to exclude any confounding from self-fulfilling prophecies.