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Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature

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Abstract

Purpose

To assess the sensitivity and false positive rate (FPR) of neurological examination and somatosensory evoked potentials (SSEPs) to predict poor outcome in adult patients treated with therapeutic hypothermia after cardiopulmonary resuscitation (CPR).

Methods

MEDLINE and EMBASE were searched for cohort studies describing the association of clinical neurological examination or SSEPs after return of spontaneous circulation with neurological outcome. Poor outcome was defined as severe disability, vegetative state and death. Sensitivity and FPR were determined.

Results

A total of 1,153 patients from ten studies were included. The FPR of a bilaterally absent cortical N20 response of the SSEP could be calculated from nine studies including 492 patients. The SSEP had an FPR of 0.007 (confidence interval, CI, 0.001–0.047) to predict poor outcome. The Glasgow coma score (GCS) motor response was assessed in 811 patients from nine studies. A GCS motor score of 1–2 at 72 h had a high FPR of 0.21 (CI 0.08–0.43). Corneal reflex and pupillary reactivity at 72 h after the arrest were available in 429 and 566 patients, respectively. Bilaterally absent corneal reflexes had an FPR of 0.02 (CI 0.002–0.13). Bilaterally absent pupillary reflexes had an FPR of 0.004 (CI 0.001–0.03).

Conclusions

At 72 h after the arrest the motor response to painful stimuli and the corneal reflexes are not a reliable tool for the early prediction of poor outcome in patients treated with hypothermia. The reliability of the pupillary response to light and the SSEP is comparable to that in patients not treated with hypothermia.

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Acknowledgments

This study was supported by the Systematic Review Group of the ESICM. The authors wish to thank Nens van Alfen, Laurens Bisschops, Eline Bouwes, Brian L. Edlow, David M. Greer, Christoph Leithner, Christoph, J. Ploner, Alejandro A. Rabinstein, Andrea O. Rossetti, Edgar Samaniego and Eelco F.M. Wijdicks for their substantial contributions to the original study conception/design, data acquisition and interpretation of data.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Intensive Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein zuid 10, Nijmegen, 6525 GA, The Netherlands

    M. J. A. Kamps & C. W. E. Hoedemaekers

  2. Department of Intensive Care, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands

    J. Horn & J. M. Binnekade

  3. Department of Intensive Care Medicine, Faculty of Biology and Medicine, Lausanne University Hospital, BH-08, Rue du Bugnon 46, CHUV, 1011, Lausanne, Switzerland

    M. Oddo

  4. Department of Neurology, 200 First St. S.W., Rochester, MN, 55905, USA

    J. E. Fugate

  5. Deparment of Intensive Care Medicine/Nephrology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    C. Storm

  6. Department of Clinical Sciences, Division of Neurology, Skåne University Hospital, Lund University, 22363, Lund, Sweden

    T. Cronberg

  7. Stanford University School of Medicine, Stanford University Medical Center, 780 Welch Road, Suite 205, Palo Alto, CA, 94304, USA

    C. A. Wijman

  8. Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, 149 13th Street, CNY 2301, Charlestown, MA, 02129, USA

    O. Wu

Authors
  1. M. J. A. Kamps
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  2. J. Horn
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  3. M. Oddo
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  4. J. E. Fugate
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  5. C. Storm
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  6. T. Cronberg
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  7. C. A. Wijman
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  8. O. Wu
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  9. J. M. Binnekade
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  10. C. W. E. Hoedemaekers
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Corresponding author

Correspondence to C. W. E. Hoedemaekers.

Additional information

C. A. Wijman is deceased

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Kamps, M.J.A., Horn, J., Oddo, M. et al. Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature. Intensive Care Med 39, 1671–1682 (2013). https://doi.org/10.1007/s00134-013-3004-y

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  • DOI: https://doi.org/10.1007/s00134-013-3004-y

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