1
|
Ishii J, Nishikimi M, Kikutani K, Kyo M, Ohki S, Ota K, Fujino M, Sakuraya M, Ohshimo S, Shime N. External validation of the rCAST for patients after in-hospital cardiac arrest: a multicenter retrospective observational study. Sci Rep 2024; 14:4284. [PMID: 38383599 PMCID: PMC10882058 DOI: 10.1038/s41598-024-54851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/17/2024] [Indexed: 02/23/2024] Open
Abstract
No established predictive or risk classification tool exists for the neurological outcomes of post-cardiac arrest syndrome (PCAS) in patients with in-hospital cardiac arrest (IHCA). This study aimed to investigate whether the revised post-cardiac arrest syndrome for therapeutic hypothermia score (rCAST), which was developed to estimate the prognosis of PCAS patients with out-of-hospital cardiac arrest (OHCA), was applicable to patients with IHCA. A retrospective, multicenter observational study of 140 consecutive adult IHCA patients admitted to three intensive care units. The area under the receiver operating characteristic curves (AUCs) of the rCAST for poor neurological outcome and mortality at 30 days were 0.88 (0.82-0.93) and 0.83 (0.76-0.89), respectively. The sensitivity and specificity of the risk classification according to rCAST for poor neurological outcomes were 0.90 (0.83-0.96) and 0.67 (0.55-0.79) for the low, 0.63 (0.54-0.74) and 0.67 (0.55-0.79) for the moderate, and 0.27 (0.17-0.37) and 1.00 (1.00-1.00) for the high-severity grades. All 22 patients classified with a high-severity grade showed poor neurological outcomes. The rCAST showed excellent predictive accuracy for neurological prognosis in patients with PCAS after IHCA. The rCAST may be useful as a risk classification tool for PCAS after IHCA.
Collapse
Affiliation(s)
- Junki Ishii
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumi-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Kazuya Kikutani
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Michihito Kyo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shingo Ohki
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mitsuhiro Fujino
- Department of Critical Care and Emergency Medicine, Otsu City Hospital, 2-9-9 Motomiya, Otsu, 520-0804, Japan
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| |
Collapse
|
2
|
Soulier T, Colliot O, Ayache N, Rohaut B. How will tomorrow's algorithms fuse multimodal data? The example of the neuroprognosis in Intensive Care. Anaesth Crit Care Pain Med 2023; 42:101301. [PMID: 37709200 DOI: 10.1016/j.accpm.2023.101301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Théodore Soulier
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013, Paris, France.
| | - Olivier Colliot
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013, Paris, France
| | | | - Benjamin Rohaut
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013, Paris, France; Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| |
Collapse
|
3
|
Lascarrou JB, Bougouin W, Chelly J, Bourenne J, Daubin C, Lesieur O, Asfar P, Colin G, Paul M, Chudeau N, Muller G, Geri G, Jacquier S, Pichon N, Klein T, Sauneuf B, Klouche K, Cour M, Sejourne C, Annoni F, Raphalen JH, Galbois A, Bruel C, Mongardon N, Aissaoui N, Deye N, Maizel J, Dumas F, Legriel S, Cariou A. Prospective comparison of prognostic scores for prediction of outcome after out-of-hospital cardiac arrest: results of the AfterROSC1 multicentric study. Ann Intensive Care 2023; 13:100. [PMID: 37819544 PMCID: PMC10567621 DOI: 10.1186/s13613-023-01195-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a heterogeneous entity with multiple origins and prognoses. An early, reliable assessment of the prognosis is useful to adapt therapeutic strategy, tailor intensity of care, and inform relatives. We aimed primarily to undertake a prospective multicentric study to evaluate predictive performance of the Cardiac Arrest Prognosis (CAHP) Score as compare to historical dataset systematically collected after OHCA (Utstein style criteria). Our secondary aim was to evaluate other dedicated scores for predicting outcome after OHCA and to compare them to Utstein style criteria. METHODS We prospectively collected data from 24 French and Belgium Intensive Care Units (ICUs) between August 2020 and June 2022. All cases of non-traumatic OHCA (cardiac and non-cardiac causes) patients with stable return of spontaneous circulation (ROSC) and comatose at ICU admission (defined by Glasgow coma score ≤ 8) on ICU admission were included. The primary outcome was the modified Rankin scale (mRS) at day 90 after cardiac arrest, assessed by phone interviews. A wide range of developed scores (CAHP, OHCA, CREST, C-Graph, TTM, CAST, NULL-PLEASE, and MIRACLE2) were included, and their accuracies in predicting poor outcome at 90 days after OHCA (defined as mRS ≥ 4) were determined using the area under the receiving operating characteristic curve (AUROC) and the calibration belt. RESULTS During the study period, 907 patients were screened, and 658 were included in the study. Patients were predominantly male (72%), with a mean age of 61 ± 15, most having collapsed from a supposed cardiac cause (64%). The mortality rate at day 90 was 63% and unfavorable neurological outcomes were observed in 66%. The performance (AUROC) of Utstein criteria for poor outcome prediction was moderate at 0.79 [0.76-0.83], whereas AUROCs from other scores varied from 0.79 [0.75-0.83] to 0.88 [0.86-0.91]. For each score, the proportion of patients for whom individual values could not be calculated varied from 1.4% to 17.4%. CONCLUSIONS In patients admitted to ICUs after a successfully resuscitated OHCA, most of the scores available for the evaluation of the subsequent prognosis are more efficient than the usual Utstein criteria but calibration is unacceptable for some of them. Our results show that some scores (CAHP, sCAHP, mCAHP, OHCA, rCAST) have superior performance, and that their ease and speed of determination should encourage their use. Trial registration https://clinicaltrials.gov/ct2/show/NCT04167891.
Collapse
Affiliation(s)
- Jean Baptiste Lascarrou
- AfterROSC Network Group, Paris, France.
- Université de Paris Cité, Inserm, Paris Cardiovascular Research Center, Paris, France.
- Service de Médecine Intensive Réanimation, University Hospital Center, 30 Boulevard Jean Monet, 44093, Nantes Cedex 9, France.
| | - Wulfran Bougouin
- AfterROSC Network Group, Paris, France
- Université de Paris Cité, Inserm, Paris Cardiovascular Research Center, Paris, France
- Médecine Intensive Réanimation, Hôpital Jacques Cartier, Massy, France
| | - Jonathan Chelly
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CH Toulon, Toulon, France
| | - Jeremy Bourenne
- AfterROSC Network Group, Paris, France
- Réanimation des Urgences et Déchocage, CHU La Timone, APHM, Marseille, France
| | - Cedric Daubin
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CHU Caen, Caen, France
| | - Olivier Lesieur
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CH La Rochelle, La Rochelle, France
| | - Pierre Asfar
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CHU Angers, Angers, France
| | - Gwenhael Colin
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CHD Vendée, La Roche-Sur-Yon, France
| | - Marine Paul
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CH Versailles, Le Chesnay, France
| | - Nicolas Chudeau
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CH Le Mans, Le Mans, France
| | - Gregoire Muller
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CHR Orléans, Orléans, France
| | - Guillaume Geri
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, APHP, CHU Ambroise Pare, Boulogne-Billancourt, France
| | - Sophier Jacquier
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CHU Tours, Tours, France
| | - Nicolas Pichon
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CH Brive-La-Gaillard, Bourges, France
| | - Thomas Klein
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CHU Nancy, Nancy, France
| | - Bertrand Sauneuf
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CH Cherbourg-en-Cotentin, Cherbourg, France
| | - Kada Klouche
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CHU Montpellier, Montpellier, France
| | - Martin Cour
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, Hospices Civils Lyon, Lyon, France
| | - Caroline Sejourne
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CH Bethune, Bethune, France
| | - Filippo Annoni
- AfterROSC Network Group, Paris, France
- Réanimation, ERASME, Brussels, Belgium
| | - Jean-Herle Raphalen
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, APHP, CHU Necker, Paris, France
| | - Arnaud Galbois
- AfterROSC Network Group, Paris, France
- Service de Réanimation Polyvalente, Hôpital Privé Claude Galien, Quincy-Sous-Sénart, France
| | - Cedric Bruel
- AfterROSC Network Group, Paris, France
- Service de Réanimation Polyvalente, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Nicolas Mongardon
- AfterROSC Network Group, Paris, France
- Service d'Anesthésie-Réanimation Chirurgicale, APHP, CHU Henri Mondor, Créteil, France
| | - Nadia Aissaoui
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, APHP, HEGP, Paris, France
| | - Nicolas Deye
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, APHP, CHU Lariboisière, Paris, France
| | - Julien Maizel
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CHU Amiens, Amiens, France
| | | | - Stephane Legriel
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, CH Versailles, Le Chesnay, France
| | - Alain Cariou
- AfterROSC Network Group, Paris, France
- Médecine Intensive Réanimation, APHP, CHU Cochin, Paris, France
| |
Collapse
|
4
|
Sugita K, Muto M, Murakami M, Yano K, Harumatsu T, Onishi S, Yamada K, Yamada W, Matsukubo M, Kawano T, Machigashira S, Torikai M, Ishihara C, Tokuhisa T, Ibara S, Ieiri S. Does protocol miconazole administration improve mortality and morbidity on surgical necrotizing enterocolitis? Pediatr Surg Int 2023; 39:102. [PMID: 36738350 DOI: 10.1007/s00383-023-05390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE Our previous clinical pilot study reported that miconazole (MCZ) prevented morbidity from surgical necrotizing enterocolitis (NEC). The present study re-investigated this effect in a long-term cohort over 20 years. METHODS We conducted a retrospective cohort study from April 1998 to March 2020. A total of 1169 extremely low-birth-weight infants (ELBWIs) admitted to our neonatal intensive care unit, including 45 with NEC (3.8%), underwent surgery. Since 2002, protocol MCZ administration for 3 weeks has been applied for neonates born before 26 weeks' gestation or weighing under 1000 g. We compared the background characteristics and clinical outcomes between patients with and without MCZ administration. RESULTS The morbidity rate decreased after applying the MCZ protocol, but no improvement in mortality was seen. A propensity score-matched analysis indicated that treated patients by MCZ showed a delay in developing surgical NEC by 12 days. The MCZ protocol also helped increase body weight at surgery. Prophylactic MCZ administration did not improve the neurological development of the language-social and postural-motor domains in the surgical NEC patients. But cognitive-adaptive domain caught up by a chronological age of 3 years old. CONCLUSIONS Revising the protocol to extend the dosing period may improve the outcomes of surgical NEC after the onset.
Collapse
Affiliation(s)
- Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Makoto Matsukubo
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Seiro Machigashira
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Motofumi Torikai
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Chie Ishihara
- Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Takuya Tokuhisa
- Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Satoshi Ibara
- Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
| |
Collapse
|
5
|
Fukushima K, Aoki M, Nakajima J, Aramaki Y, Ichikawa Y, Isshiki Y, Sawada Y, Oshima K. Favorable prognosis by extracorporeal cardiopulmonary resuscitation for subsequent shockable rhythm patients. Am J Emerg Med 2022; 53:144-149. [PMID: 35051701 DOI: 10.1016/j.ajem.2022.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) patients who convert from an initial non-shockable rhythm to a subsequent shockable rhythm reportedly have a better prognosis for survival than those without rhythm conversion. We evaluated the effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for OHCA patients with a subsequent shockable rhythm. METHODS This study was conducted using the Japanese Association of Acute Medicine OHCA registry. We included OHCA patients with a subsequent shockable rhythm from June 2014 to December 2017. The included patients were divided into those with and without ECPR. The primary outcome was 30-day survival. Logistic regression analysis and propensity score matching were performed to compare the outcomes between patients with and without ECPR. RESULTS A total of 2,102 patients were analyzed, consisting of 162 with ECPR and 1,940 without ECPR. Before propensity score matching, 24 (14.8%) patients with ECPR and 61 (3.1%) patients without ECPR survived for 30 days; ECPR was associated with increased survival (P < 0.05; odds ratio [OR], 5.35; 95% confidence interval [CI], 3.09-9.02). After propensity score matching, 22/149 (14.8%) patients with ECPR and 10/149 (6.7%) patients without ECPR survived for 30 days; ECPR was associated with increased survival (P < 0.05; OR, 2.40; 95% CI, 1.04-5.91). CONCLUSIONS ECPR was associated with increased survival among OHCA patients with a subsequent shockable rhythm.
Collapse
Affiliation(s)
- Kazunori Fukushima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Jun Nakajima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuto Aramaki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yumi Ichikawa
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuta Isshiki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Yusuke Sawada
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| |
Collapse
|
6
|
Yasuda Y, Nishikimi M, Matsui K, Numaguchi A, Nishida K, Emoto R, Matsui S, Matsuda N. The rCAST score is useful for estimating the neurological prognosis in pediatric patients with post-cardiac arrest syndrome before ICU admission: External validation study using a nationwide prospective registry. Resuscitation 2021; 168:103-109. [PMID: 34600971 DOI: 10.1016/j.resuscitation.2021.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/13/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objective of this cohort study was to investigate whether the revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia score (rCAST), which we previously developed as a prognostic score for adult patients with post-cardiac arrest syndrome (PCAS), is also applicable to pediatric patients. METHODS Pediatric PCAS patients were included from an out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM). We validated the predictive accuracy of the rCAST for the neurological outcomes at 30 and 90 days. We also evaluated the probability of a good neurological outcome in each of the three specified severity categories based on the rCAST (low severity: ≤5.5; moderate severity: 6.0-14.0; high severity: ≥14.5). RESULTS Among the 737 pediatric patients with OHCA, the data of 179 pediatric PCAS patients in whom return of spontaneous circulation was achieved were analyzed. The areas under the curve (AUC) of the rCAST for predicting the neurological outcomes at 30 days and 90 days were 0.95 (95% CI: 0.90-0.99) and 0.96 (0.91-1.00), respectively. The proportions of patients with a good neurological outcome at 30 days were 100% (12/12) in the low severity group, 36.1% (13/36) in the moderate severity group, and 2.3% (3/131) in the high severity group. CONCLUSIONS The AUC of the rCAST for pediatric PCAS patients was found to be greater than 0.9 in the external validation, which corresponds to excellent predictive accuracy. There was no patient with good neurological outcome among the patients with more than 17.0 points (extremely high severity group).
Collapse
Affiliation(s)
- Yuma Yasuda
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan; Laboratory for Critical Care Physiology at the Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Department of Emergency Medicine, Northwell Health, NY, USA
| | - Kota Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Numaguchi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuki Nishida
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryo Emoto
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeyuki Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoyuki Matsuda
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
7
|
Lilja L, Joelsson S, Nilsson J, Lindgren S, Rylander C. Application of a standardized EEG pattern classification in the assessment of neurological prognosis after cardiac arrest: A retrospective analysis. Resuscitation 2021; 165:38-44. [PMID: 34119554 DOI: 10.1016/j.resuscitation.2021.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/15/2021] [Accepted: 05/30/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Electroencephalogram (EEG) is used in the neurological prognostication after cardiac arrest. "Highly malignant" EEG patterns classified according to Westhall have a high specificity for poor neurological outcome when applied within protocols of recent studies. However, their predictive performance when applied in everyday clinical practice has not been investigated. We studied the prognostic accuracy and the interrater agreement when standardized EEG patterns were analysed and compared to neurological outcome in a patient cohort at a tertiary centre not involved in the original study of the standardized EEG pattern classification. METHODS Comatose patients treated for out-of-hospital cardiac arrest were included. Poor outcome was defined as Cerebral Performance Category 3-5. Two senior consultants and one resident in clinical neurophysiology, blinded to clinical data and outcome, independently reviewed their EEG registrations and categorised the pattern as "highly malignant", "malignant" or "benign". These categories were compared to neurological outcome at hospital discharge. Interrater agreement was assessed using Cohen's Kappa. RESULTS In total, 62 patients were included. The median (IQR) time to EEG was 59 (42-91) h after return of spontaneous circulation. Poor outcome was found in 52 (84%) patients. In 21 patients at least one of the raters considered the EEG to contain a "highly malignant" pattern, all with poor outcome (42% sensitivity, 100% specificity). The interrater agreement varied from kappa 0.62 to 0.29. CONCLUSION "Highly malignant" patterns predict poor neurological outcome with a high specificity in everyday practice. However, interrater agreement may vary substantially even between experienced EEG interpreters.
Collapse
|
8
|
Carrai R, Spalletti M, Scarpino M, Lolli F, Lanzo G, Cossu C, Bonizzoli M, Socci F, Lazzeri C, Amantini A, Grippo A. Are neurophysiologic tests reliable, ultra-early prognostic indices after cardiac arrest? Neurophysiol Clin 2021; 51:133-144. [PMID: 33573889 DOI: 10.1016/j.neucli.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Determining early and reliable prognosis in comatose subjects after cardiac arrest is a central component of post-cardiac arrest care both for developing realistic prognostic expectations for families, and for better determining which resources are mobilized or withheld for individual patients. The aim of the study was to evaluate the prognostic accuracy of EEG and SEP patterns during the very early period (within the first 6 h) after cardiac arrest. METHODS We retrospectively analysed comatose patients after CA, either inside or outside the hospital, in which prognostic evaluation was made during the first 6 h from CA. Prognostic evaluation comprised clinical evaluation (GCS and pupillary light reflex) and neurophysiological (electroencephalography (EEG) and somatosensory evoked potentials (SEP)) studies. Prognosis was evaluated with regards to likelihood of recovery of consciousness and also likelihood of failure to regain consciousness. RESULTS Forty-one comatose patients after cardiac arrest were included. All patients with continuous and nearly continuous EEG recovered consciousness. Isoelectric EEG was always associated with poor outcome. Burst-suppression, suppression and discontinuous patterns were usually associated with poor outcome although some consciousness recovery was observed. Bilaterally absent SEP responses were always associated with poor outcome. Continuous and nearly continuous EEG patterns were never associated with bilaterally absent SEP. CONCLUSIONS During the very early period following cardiac arrest (first 6 h), EEG and SEP maintain their high predictive value to predict respectively recovery and failure of recovery of consciousness. A very early EEG exam allows identification of patients with very high probability of a good outcome, allowing rapid use of the most appropriate therapeutic procedures.
Collapse
Affiliation(s)
- Riccardo Carrai
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; IRCCS, Fondazione Don Carlo Gnocchi, Florence, Italy.
| | - Maddalena Spalletti
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; IRCCS, Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Maenia Scarpino
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; IRCCS, Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Francesco Lolli
- Dipartimento di Scienze Biomediche Mario Serio, Università di Firenze, Florence, Italy
| | - Giovanni Lanzo
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy
| | - Cesarina Cossu
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy
| | - Manuela Bonizzoli
- Unità di Terapia Intensiva, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy
| | - Filippo Socci
- Unità di Terapia Intensiva, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy
| | - Chiara Lazzeri
- Unità di Terapia Intensiva, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy
| | - Aldo Amantini
- IRCCS, Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Antonello Grippo
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; IRCCS, Fondazione Don Carlo Gnocchi, Florence, Italy
| |
Collapse
|
9
|
Lilja L, Joelsson S, Nilsson J, Thuccani M, Lundgren P, Lindgren S, Rylander C. Assessing neurological prognosis in post-cardiac arrest patients from short vs plain text EEG reports: A survey among intensive care clinicians. Resuscitation 2020; 159:7-12. [PMID: 33359178 DOI: 10.1016/j.resuscitation.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/18/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Electroencephalography (EEG) patterns are predictive of neurological prognosis in comatose survivors from cardiac arrest but intensive care clinicians are dependent of neurophysiologist reports to identify specific patterns. We hypothesized that the proportion of correct assessment of neurological prognosis would be higher from short statements confirming specific EEG patterns compared with descriptive plain text reports. METHODS Volunteering intensive care clinicians at two university hospitals were asked to assess the neurological prognosis of a fictional patient with high neuron specific enolase. They were presented with 17 authentic plain text reports and three short statements, confirming whether a "highly malignant", "malignant" or "benign" EEG pattern was present. Primary outcome was the proportion of clinicians who correctly identified poor neurological prognosis from reports consistent with highly malignant EEG patterns. Secondary outcomes were how the prognosis was assessed from reports consistent with malignant and benign patterns. RESULTS Out of 57 participants, poor prognosis was correctly identified by 61% from plain text reports and by 93% from the short statement "highly malignant" EEG patterns. Unaffected prognosis was correctly identified by 28% from plain text reports and by 40% from the short statement "malignant" patterns. Good prognosis was correctly identified by 64% from plain text reports and by 93% from the short statement "benign" pattern. CONCLUSION Standardized short statement, "highly malignant EEG pattern present", as compared to plain text EEG descriptions in neurophysiologist reports, is associated with more accurate identification of poor neurological prognosis in comatose survivors of cardiac arrest.
Collapse
Affiliation(s)
- Linus Lilja
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Sara Joelsson
- Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefin Nilsson
- Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Meena Thuccani
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Lundgren
- Prehospen - Centre for Prehospital Research, University of Borås, Borås, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sophie Lindgren
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christian Rylander
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
10
|
Storm C, Behringer W, Wolfrum S, Michels G, Fink K, Kill C, Arrich J, Leithner C, Ploner C, Busch HJ. [Postcardiac arrest treatment guide]. Med Klin Intensivmed Notfmed 2019; 115:573-584. [PMID: 31197420 DOI: 10.1007/s00063-019-0591-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/28/2019] [Accepted: 05/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment after cardiac arrest has become more complex and interdisciplinary over the last few years. Thus, the clinically active intensive and emergency care physician not only has to carry out the immediate care and acute diagnostics, but also has to prognosticate the neurological outcome. AIM The different, most important steps are presented by leading experts in the area, taking into account the interdisciplinarity and the currently valid guidelines. MATERIALS AND METHODS Attention was paid to a concise, practice-oriented presentation. RESULTS AND DISCUSSION The practical guide contains all important steps from the acute care to the neurological prognosis generation that are relevant for the clinically active intensive care physician.
Collapse
Affiliation(s)
- C Storm
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - W Behringer
- Zentrum für Notfallmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - S Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikum Lübeck, Lübeck, Deutschland
| | - G Michels
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Köln, Deutschland
| | - K Fink
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg Breisgau, Deutschland
| | - C Kill
- Zentrum für Notfallmedizin, Universitätsklinikum Essen, Essen, Deutschland
| | - J Arrich
- Zentrum für Notfallmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - C Leithner
- Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Ploner
- Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg Breisgau, Deutschland.
| |
Collapse
|
11
|
Nishikimi M, Ogura T, Nishida K, Takahashi K, Nakamura M, Matsui S, Matsuda N, Iwami T. External validation of a risk classification at the emergency department of post-cardiac arrest syndrome patients undergoing targeted temperature management. Resuscitation 2019; 140:135-41. [PMID: 31153943 DOI: 10.1016/j.resuscitation.2019.05.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/09/2019] [Accepted: 05/23/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION There are no established risk classification for post-cardiac arrest syndrome (PCAS) patients at the Emergency Department (ED) undergoing targeted temperature management (TTM). The aim of this study was to externally validate a simplified version of our prognostic score, the "post-Cardiac Arrest Syndrome for Therapeutic hypothermia score" (revised CAST [rCAST]) and estimate the predictive accuracy of the risk classification based on it. METHODS For the external validation, we used data from an out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM), which is a multicenter, prospective registry of OHCA patients across Japan. Eligible patients were PCAS patients treated with TTM at 33-36 °C between June 2014 and December 2015. We validated the accuracy of rCAST for predicting the neurological outcomes at 30 and 90 days. RESULTS Among the 12,024 OHCA patients, the data of 460 PCAS patients treated by TTM were eligible for the validation. The areas under the curve of rCAST for predicting the neurological outcomes at 30 and 90 days were 0.892 and 0.895, respectively. The estimated sensitivity and specificity of the risk categories for the outcomes were as follows: 0.95 (95% CI: 0.92-0.98) and 0.47 (0.40-0.55) for the low (rCAST: ≤5.5), 0.62 (0.56-0.68) and 0.48 (0.40-0.55) for the moderate (rCAST: 6.0-14.0), and 0.57 (0.51-0.63) and 0.95 (0.91-0.98) for the high severity category (rCAST: ≥14.5). CONCLUSIONS The rCAST was useful for predicting the neurological outcomes with high accuracy in PCAS patients, and the three grades was developed for a risk classification based on the rCAST.
Collapse
|
12
|
Martínez-Losas P, López de Sá E, Armada E, Rosillo S, Monedero MC, Rey JR, Caro-Codón J, Buño Soto A, López Sendón JL. Neuron-specific enolase kinetics: an additional tool for neurological prognostication after cardiac arrest. ACTA ACUST UNITED AC 2020; 73:123-30. [PMID: 30857978 DOI: 10.1016/j.rec.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/14/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION AND OBJECTIVES To analyze neuron-specific enolase (NSE) kinetics as a prognostic biomarker of neurological outcome in cardiac arrest survivors treated with targeted temperature management. METHODS We performed a retrospective analysis of patients resuscitated from in- or out-of-hospital cardiac arrest admitted from September 2006 to May 2018 in a single tertiary care center and cooled to 32°C to 34°C for 24 hours. Blood samples for measurement of NSE values were drawn at hospital admission and at 24, 48, and 72hours after return of spontaneous circulation (ROSC). Neurological outcome was evaluated by means of the Cerebral Performance Category (CPC) score at 3 months and was characterized as good (CPC 1-2) or poor (CPC 3-5). RESULTS Of 451 patients, 320 fulfilled the inclusion criteria and were analyzed (80.3% male, mean age 61±14.1 years). Among these, 174 patients (54.4%) survived with good neurological status. Poor outcome patients had higher median NSE values at hospital admission and at 24, 48 and 72 hours after ROSC. At 48 and 72 hours after ROSC, NSE predicted poor neurological outcome with areas under the receiver-operating characteristic curves of 0.85 (95%CI, 0.81-0.90) and 0.88 (95%CI, 0.83-0.93), respectively. In addition, delta NSE values between 72hours after ROSC and hospital admission predicted poor neurological outcome with an area under the receiver-operating characteristic curve of 0.90 (95%CI, 0.85-0.95) and was an independent predictor of unfavorable outcome on multivariate analysis (P <.001). CONCLUSIONS In cardiac arrest survivors treated with targeted temperature management, delta NSE values between 72 hours after ROSC and hospital admission strongly predicted poor neurological outcome.
Collapse
|
13
|
Nishikimi M, Ogura T, Matsui K, Takahashi K, Fukaya K, Liu K, Morita H, Nakamura M, Matsui S, Matsuda N. Accuracy of the first interpretation of early brain CT images for predicting the prognosis of post-cardiac arrest syndrome patients at the emergency department. J Intensive Care 2018; 6:26. [PMID: 29721320 PMCID: PMC5918845 DOI: 10.1186/s40560-018-0296-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Early brain CT is one of the most useful tools for estimating the prognosis in patients with post-cardiac arrest syndrome (PCAS) at the emergency department (ED). The aim of this study was to evaluate the prognosis-prediction accuracy of the emergency physicians' interpretation of the findings on early brain CT in PCAS patients treated by targeted temperature management (TTM). Methods This was a double-center, retrospective, observational study. Eligible subjects were cardiac arrest patients admitted to the intensive care unit (ICU) for TTM between April 2011 and March 2017. We performed the McNemar test to compare the predictive accuracies of the interpretation by emergency physicians and radiologists and calculated the kappa statistic for determining the concordance rate between the interpretations by these two groups. Results Of the 122 eligible patients, 106 met the inclusion criteria for this study. The predictive accuracies (sensitivity, specificity) of the interpretations by the emergency physicians and radiologists were (0.34, 1.00) and (0.41, 0.93), respectively, with no significant difference in either the sensitivity or specificity as assessed by the McNemar test. The kappa statistic calculated to determine the concordance between the two interpretations was 0.66 (0.48-0.83), which showed a good conformity. Conclusions The emergency physicians' interpretation of the early brain CT findings in PCAS patients treated by TTM was as reliable as that of radiologists, in terms of prediction of the prognosis.
Collapse
Affiliation(s)
- Mitsuaki Nishikimi
- 1Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 64, Syowa-ku, Nagoya, Aichi 466-8560 Japan
| | - Takayuki Ogura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kota Matsui
- 3Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiko Takahashi
- 3Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Fukaya
- 1Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 64, Syowa-ku, Nagoya, Aichi 466-8560 Japan
| | - Keibun Liu
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Hideo Morita
- Department of Diagnostic Radiology, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsunobu Nakamura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Shigeyuki Matsui
- 3Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoyuki Matsuda
- 1Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 64, Syowa-ku, Nagoya, Aichi 466-8560 Japan
| |
Collapse
|
14
|
Nishikimi M, Ogura T, Nishida K, Takahashi K, Fukaya K, Liu K, Nakamura M, Matsui S, Matsuda N. Differential effect of mild therapeutic hypothermia depending on the findings of hypoxic encephalopathy on early CT images in patients with post-cardiac arrest syndrome. Resuscitation 2018; 128:11-15. [PMID: 29698752 DOI: 10.1016/j.resuscitation.2018.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/29/2018] [Accepted: 04/23/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the differential effects of mild therapeutic hypothermia (MTH) in post-cardiac arrest syndrome (PCAS) patients depending on the presence/absence of hypoxic encephalopathy (HE) in the early brain CT images obtained before the initiation of MTH. METHODS We conducted a retrospective review of the data of a total of 129 patients with PCAS who were treated by MTH (34 °C) or normothermia treatment (NT) (35 °C or 36 °C), and had undergone brain CT examination prior to the initiation of these treatments. We divided the subjects into 4 groups, namely, the HE(-)/MTH, HE(-)/NT, HE(+)/MTH, and HE(+)/NT groups, for evaluating the interaction effect between the two variables. Then, we compared the neurological outcomes between the HE(-)/MTH and HE(-)/NT groups by multivariate logistic analysis. Good outcome was defined as a Cerebral Performance Category score of ≤2 at 30 days. RESULTS The percentages of subjects with a good outcome in the HE(-)/MTH and HE(-)/NT group were 68.9% (42/61) and 36.1% (13/36), respectively (p = .003), while those in the HE(+)/MTH and HE(+)/NT groups were lower, at 7.4% (2/27) and 20.0% (1/5), respectively (p = .410), suggesting a statistically significant interaction effect between the two variables (pinteraction = 0.002). In the HE(-) group, MTH was associated with a higher odds ratio of a good outcome as compared to NT (OR 6.80, 95% CI 1.19-38.96, p = .031). CONCLUSIONS The effect of MTH in patients with PCAS differed depending on the presence/absence of evidence of HE on the early CT images.
Collapse
Affiliation(s)
- Mitsuaki Nishikimi
- Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Takayuki Ogura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kazuki Nishida
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Fukaya
- Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keibun Liu
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsunobu Nakamura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Shigeyuki Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoyuki Matsuda
- Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
15
|
Nishikimi M, Matsuda N, Matsui K, Takahashi K, Ejima T, Liu K, Ogura T, Higashi M, Umino H, Makishi G, Numaguchi A, Matsushima S, Tokuyama H, Nakamura M, Matsui S. A novel scoring system for predicting the neurologic prognosis prior to the initiation of induced hypothermia in cases of post-cardiac arrest syndrome: the CAST score. Scand J Trauma Resusc Emerg Med 2017; 25:49. [PMID: 28490379 PMCID: PMC5424379 DOI: 10.1186/s13049-017-0392-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/04/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to develop a scoring system for identifying the post-cardiac arrest syndrome (PCAS) patients with a good potential for recovery prior to the initiation of induced therapeutic hypothermia. METHODS A multi-center, retrospective, observational study was performed. Data of a total of 151 consecutive adults who underwent induced hypothermia after cardiac arrest (77 learning cases from two hospitals and 74 validation cases from two other hospitals) were analyzed. RESULTS In the learning set, 8 factors (initial rhythm, witnessed status and time until return of spontaneous circulation, pH, serum lactate, motor score according to the Glasgow Coma Scale (GCS), gray matter attenuation to white matter attenuation ratio (GWR), serum albumin, and hemoglobin) were found to be strongly correlated with the neurological outcomes. A tentative scoring system was created from the learning data using these factors, and the predictive accuracy (sensitivity and specificity) was evaluated in terms of both internal validation (0.85 and 0.84) and external validation (cutoff 50%: 0.95 and 0.90, 30%: 0.87 and 0.98, 15%: 0.67 and 1.00). Finally, using all the data, we established a post-Cardiac Arrest Syndrome for induced Therapeutic hypothermia (CAST) score to predict the neurologic prognosis prior to initiation of induced hypothermia. CONCLUSIONS The CAST score was developed to predict the neurological outcomes of PCAS patients treated by induced hypothermia. The likelihood of good recovery at 30 days was extremely low in PCAS patients with a CAST score of ≤15%. Prospective validation of the score is needed in the future.
Collapse
Affiliation(s)
- Mitsuaki Nishikimi
- Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Syowa-ku, Nagoya, Aichi, 4668560, Japan.
| | - Naoyuki Matsuda
- Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Syowa-ku, Nagoya, Aichi, 4668560, Japan
| | - Kota Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Syowa-ku, Nagoya, Aichi, 4668560, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Syowa-ku, Nagoya, Aichi, 4668560, Japan
| | - Tadashi Ejima
- Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Syowa-ku, Nagoya, Aichi, 4668560, Japan
| | - Keibun Liu
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Asahi-cho 3-21-36, Maebashi, Gunma, 3710014, Japan
| | - Takayuki Ogura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Asahi-cho 3-21-36, Maebashi, Gunma, 3710014, Japan
| | - Michiko Higashi
- Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Syowa-ku, Nagoya, Aichi, 4668560, Japan
| | - Hitoshi Umino
- Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Syowa-ku, Nagoya, Aichi, 4668560, Japan
| | - Go Makishi
- Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Syowa-ku, Nagoya, Aichi, 4668560, Japan
| | - Atsushi Numaguchi
- Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Syowa-ku, Nagoya, Aichi, 4668560, Japan
| | - Satoru Matsushima
- Department of Emergency and Critical Care, Cyutouen General Medical Center, Shobugaike 1-1, Kakegawa, Shizuoka, 4368555, Japan
| | - Hideki Tokuyama
- Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Syowa-ku, Nagoya, Aichi, 4668560, Japan
| | - Mitsunobu Nakamura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Asahi-cho 3-21-36, Maebashi, Gunma, 3710014, Japan
| | - Shigeyuki Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Syowa-ku, Nagoya, Aichi, 4668560, Japan
| |
Collapse
|
16
|
Loire M, Barat M, Mangyanda Kinkembo L, Lenhardt F, M'buila C. Spontaneous ping-pong parietal fracture in a newborn. Arch Dis Child Fetal Neonatal Ed 2017; 102:F160-F161. [PMID: 27645490 DOI: 10.1136/archdischild-2016-311232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/11/2016] [Accepted: 08/26/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Mathilde Loire
- Service de Pédiatrie, Groupe Hospitalier Carnelle Portes de l'Oise, Beaumont sur Oise, Île-de-France, France
| | - Maxime Barat
- Department of Radiology, Groupe Hospitalier Carnelle Portes de l'Oise, Beaumont-sur-Oise, Île-de-France, France
| | - Laurent Mangyanda Kinkembo
- Department of Pediatrics, Groupe Hospitalier Carnelle Portes de l'Oise, Beaumont sur Oise, Île-de-France, France
| | - Florence Lenhardt
- Department of Obstetrics, Groupe Hospitalier Carnelle Portes de l'Oise, Beaumont-sur-Oise, Île-de-France, France
| | - Célestin M'buila
- Department of Pediatrics, Groupe Hospitalier Carnelle Portes de l'Oise, Beaumont sur Oise, Île-de-France, France
| |
Collapse
|
17
|
Elmer J, Torres C, Aufderheide TP, Austin MA, Callaway CW, Golan E, Herren H, Jasti J, Kudenchuk PJ, Scales DC, Stub D, Richardson DK, Zive DM. Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest. Resuscitation 2016; 102:127-35. [PMID: 26836944 DOI: 10.1016/j.resuscitation.2016.01.016] [Citation(s) in RCA: 271] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 12/29/2015] [Accepted: 01/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Withdrawing life-sustaining therapy because of perceived poor neurological prognosis (WLST-N) is a common cause of hospital death after out-of-hospital cardiac arrest (OHCA). Although current guidelines recommend against WLST-N before 72h (WLST-N<72), this practice is common and may increase mortality. We sought to quantify these effects. METHODS In a secondary analysis of a multicenter OHCA trial, we evaluated survival to hospital discharge and survival with favorable functional status (modified Rankin Score ≤3) in adults alive >1h after hospital admission. Propensity score modeling the probability of exposure to WLST-N<72 based on pre-exposure covariates was used to match unexposed subjects with those exposed to WLST-N<72. We determined the probability of survival and functionally favorable survival in the unexposed matched cohort, fit adjusted logistic regression models to predict outcomes in this group, and then used these models to predict outcomes in the exposed cohort. Combining these findings with current epidemiologic statistics we estimated mortality nationally that is associated with WLST-N<72. RESULTS Of 16,875 OHCA subjects, 4265 (25%) met inclusion criteria. WLST-N<72 occurred in one-third of subjects who died in-hospital. Adjusted analyses predicted that exposed subjects would have 26% survival and 16% functionally favorable survival if WLST-N<72 did not occur. Extrapolated nationally, WLST-N<72 may be associated with mortality in approximately 2300 Americans each year of whom nearly 1500 (64%) might have had functional recovery. CONCLUSIONS After OHCA, death following WLST-N<72 may be common and is potentially avoidable. Reducing WLST-N<72 has national public health implications and may afford an opportunity to decrease mortality after OHCA.
Collapse
Affiliation(s)
- Jonathan Elmer
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA; Department of Emergency Medicine, University of Pittsburgh, Iroquois Building Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA 15213, USA.
| | - Cesar Torres
- Department of Biostatistics, University of Washington, F-600, Health Sciences Building, NE Pacific Street, Seattle, WA 98195, USA
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, 9200W. Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Michael A Austin
- Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Associate Medical Director Regional Paramedic Program Eastern Ontario, Canada
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Eyal Golan
- Interdepartmental Division of Critical Care and Department of Medicine, University of Toronto, Toronto, ON, Canada; Critical Care Medicine, University Health Network, 399 Bathurst Street, Room 2MCL-411J, M5T-2S8, Toronto, ON, Canada
| | - Heather Herren
- Resuscitations Outcome Consortium Clinical Trial Center, University of Washington, 1107 NE 45th St., Suite 505, Seattle, WA 98105-4680, USA
| | - Jamie Jasti
- Department of Emergency Medicine, Medical College of Wisconsin, 9200W. Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Peter J Kudenchuk
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-6422, USA
| | - Damon C Scales
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D108, Toronto, ON, Canada M4 N 3M5
| | - Dion Stub
- St Paul's Hospital, Vancouver, BC, Canada; Baker IDI Institute Heart and Diabetes Institute, Melbourne, Australia
| | - Derek K Richardson
- Department of Emergency Medicine, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Dana M Zive
- Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code CDW-EM, Portland, OR 97239, USA
| |
Collapse
|
18
|
Tolan NV, Vidal-Folch N, Algeciras-Schimnich A, Singh RJ, Grebe SKG. Individualized correction of neuron-specific enolase (NSE) measurement in hemolyzed serum samples. Clin Chim Acta 2013; 424:216-21. [PMID: 23778024 DOI: 10.1016/j.cca.2013.06.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/22/2013] [Accepted: 06/06/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accuracy of serum neuron-specific enolase (NSE) measurement is paramount, particularly in the context of neurological outcome prognostication. However, NSE measurements are compromised by even slight hemolysis, as it is abundant in red blood cells (RBCs). We derived and validated an individualized hemolysis correction equation in an attempt to reduce the current rejection rate of 14% at our institution. METHODS Intracellular NSE was measured in RBC lysates to determine concentration variability. A correction equation was derived, accounting for both RBC-derived NSE false-elevation and hemoglobin-derived signal quenching. The performance of this individualized correction was evaluated in intentionally hemolyzed samples and accuracy was compared to a generalized correction. RESULTS Significant inter-individual variability of RBC NSE was observed, with an almost two-fold range (15.7-28.5 ng NSE/mg Hb, p<0.001); intra-individual variability was insignificant. The individualized hemolysis correction equation derived: NSE(corr)=NSE(meas)-(Hb(serum))(NSE(RBCs/Hb))+0.0844(Hb(serum))+1.1 corrected 95% of the intentionally hemolyzed samples to within ±5 ng/ml of corresponding baseline NSE concentrations, compared to 74% using a generalized formula. CONCLUSIONS The individualized hemolysis correction provides increased accuracy in the estimation of true serum NSE concentrations for hemolyzed samples, compared to a generalized approach, by accounting for inter-individual RBC NSE variability. Incorporating this correction should reduce sample rejection rates and overall health care costs.
Collapse
Affiliation(s)
- Nicole V Tolan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | | | | | | | | |
Collapse
|
19
|
Harvey ME, Nongena P, Gonzalez-Cinca N, Edwards AD, Redshaw ME. Parents' experiences of information and communication in the neonatal unit about brain imaging and neurological prognosis: a qualitative study. Acta Paediatr 2013; 102:360-5. [PMID: 23298288 DOI: 10.1111/apa.12154] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 10/19/2012] [Accepted: 01/03/2013] [Indexed: 11/27/2022]
Abstract
AIM To explore parental information and communication needs during their baby's care in the neonatal unit with a focus on brain imaging and neurological prognosis. METHODS Eighteen parents recruited from one neonatal unit in the United Kingdom participated in semi-structured qualitative interviews using a grounded theory approach. The topic guide focused on information received about neonatal brain imaging, diagnosis and prognosis, emotional impact and support. RESULTS Parents expressed different information needs influenced by their history, expectations, coping strategies and experiences. Most felt they initially were passive recipients of information and attempted to gain control of the information flow. Nurses were the main providers of information; doctors and other parents were also valuable. Attending ward rounds was important. Some parents felt accessing specific information such as the results of brain imaging could be difficult. Concerns about long-term developmental outcomes and the need for information did not diminish over time. The emotional impact of having a preterm baby had a negative effect on parents' ability to retain information, and all had an ongoing need for reassurance. CONCLUSION The findings provide insights about the needs and experiences of parents who have a continuing requirement for information about their infant's care, development and prognosis.
Collapse
Affiliation(s)
- Merryl E Harvey
- Centre for the Developing Brain; Imperial College London and MRC Clinical Sciences Centre; Hammersmith Hospital; London UK
| | - Phumza Nongena
- Centre for the Developing Brain; Imperial College London and MRC Clinical Sciences Centre; Hammersmith Hospital; London UK
| | - Nuria Gonzalez-Cinca
- Centre for the Developing Brain; Imperial College London and MRC Clinical Sciences Centre; Hammersmith Hospital; London UK
| | - A David Edwards
- Centre for the Developing Brain; Imperial College London and MRC Clinical Sciences Centre; Hammersmith Hospital; London UK
| | - Maggie E. Redshaw
- National Perinatal Epidemiology Unit; University of Oxford; Oxford UK
| | | |
Collapse
|