Multimodal Outcome Prognostication After Cardiac Arrest and Targeted Temperature Management: Analysis at 36 °C

Abstract

Background

Targeted temperature management (TTM) represents the standard of care in comatose survivors after cardiac arrest (CA) and may be applied targeting 33° or 36 °C. While multimodal prognostication has been extensively tested for 33 °C, scarce information exists for 36 °C.

Methods

In this cohort study, consecutive comatose adults after CA treated with TTM at 36 °C between July 2014 and October 2016 were included. A combination of neurological examination, electrophysiological features, and serum neuron-specific enolase (NSE) was evaluated for outcome prediction at 3 months (mortality; good outcome defined as cerebral performance categories (CPC) score of 1–2, poor outcome defined as CPC 3–5).

Results

We analyzed 61 patients. The presence of two or more predictors out of, unreactive electroencephalogram (EEG) background, epileptiform EEG, absent pupillary and/or corneal reflex, early myoclonus, bilaterally absent cortical somatosensory evoked potentials, and serum NSE >75 μg/l, had a high specificity for predicting mortality (positive predictive value [PPV] = 1.00, 95% CI 0.87–1.00) and poor outcome (PPV = 1.00, 95% CI 0.80–1.00). Reactive EEG background was highly sensitive for predicting good outcome (0.95, 95% CI 0.74–0.99).

Conclusions

Prediction of outcome after CA and TTM targeting 36 °C seems valid in adults using the same features tested at 33 °C. A reactive EEG under TTM appears highly sensitive for good outcome.

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Acknowledgements

The authors thank Christine Stähli, RN, and Elsa Juan, PhD, for help in data acquisition.

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Correspondence to Andrea O. Rossetti.

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Tsetsou, S., Novy, J., Pfeiffer, C. et al. Multimodal Outcome Prognostication After Cardiac Arrest and Targeted Temperature Management: Analysis at 36 °C. Neurocrit Care 28, 104–109 (2018). https://doi.org/10.1007/s12028-017-0393-8

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Keywords

  • Cardiac arrest
  • Prognostication
  • Electroencephalogram