A structured approach to neurologic prognostication in clinical cardiac arrest trials

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Niklas Nielsen³  Hans Friberg¹  Michael A Kuiper²  Janneke Horn⁴  Tobias Cronberg⁵ 

[1] Department of Intensive and Perioperative Care, Skane University Hospital, Lund, Sweden;Department of Intensive Care Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands;Department of Anesthesia and Intensive Care, Helsingborg University Hospital, Helsingborg, Sweden;Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands;Department of Neurology, Skane University Hospital, Lund, Sweden

关键词: Target temperature;    Hypothermia;    Prognosis;    Cardiac arrest;   

Others  :  811042
DOI  :  10.1186/1757-7241-21-45

 received in 2013-02-15, accepted in 2013-05-29,  发布年份 2013

【 摘 要 】

Brain injury is the dominant cause of death for cardiac arrest patients who are admitted to an intensive care unit, and the majority of patients die after withdrawal of life sustaining therapy (WLST) based on a presumed poor neurologic outcome. Mild induced hypothermia was found to decrease the reliability of several methods for neurological prognostication. Algorithms for prediction of outcome, that were developed before the introduction of mild hypothermia after cardiac arrest, may have affected the results of studies with hypothermia-treated patients. In previous trials on neuroprotection after cardiac arrest, including the pivotal hypothermia trials, the methods for prognostication and the reasons for WLST were not reported and may have had an effect on outcome. In the Target Temperature Management trial, in which 950 cardiac arrest patients have been randomized to treatment at 33°C or 36°C, neuroprognostication and WLST-decisions are strictly protocolized and registered. Prognostication is delayed to at least 72 hours after the end of the intervention period, thus a minimum of 4.5 days after the cardiac arrest, and is based on multiple parameters to account for the possible effects of hypothermia.

【 授权许可】

   
2013 Cronberg et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Atwood C, Eisenberg MS, Herlitz J, Rea TD: Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 2005, 67:75-80.
• [2]Rea TD, Eisenberg MS, Sinibaldi G, White RD: Incidence of EMS-treated out-of-hospital cardiac arrest in the United States. Resuscitation 2004, 63:17-24.
• [3]Adielsson A, Hollenberg J, Karlsson T, Lindqvist J, Lundin S, Silfverstolpe J, Svensson L, Herlitz J: Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective. Heart 2011, 97:1391-1396.
• [4]Lund-Kordahl I, Olasveengen TM, Lorem T, Samdal M, Wik L, Sunde K: Improving outcome after out-of-hospital cardiac arrest by strengthening weak links of the local Chain of Survival; quality of advanced life support and post-resuscitation care. Resuscitation 2010, 81:422-426.
• [5]Herlitz J, Engdahl J, Svensson L, Angquist KA, Silfverstolpe J, Holmberg S: Major differences in 1-month survival between hospitals in Sweden among initial survivors of out-of-hospital cardiac arrest. Resuscitation 2006, 70:404-409.
• [6]Langhelle A, Tyvold SS, Lexow K, Hapnes SA, Sunde K, Steen PA: In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway. Resuscitation 2003, 56:247-263.
• [7]HACA-trial study group: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002, 346:549-556.
• [8]Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002, 346:557-563.
• [9]Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, Perkins GD: European resuscitation council guidelines for resuscitation 2010 section 4. Adult advanced life support. Resuscitation 2010, 81:1305-1352.
• [10]Castren M, Silfvast T, Rubertsson S, Niskanen M, Valsson F, Wanscher M, Sunde K: Scandinavian clinical practice guidelines for therapeutic hypothermia and post-resuscitation care after cardiac arrest. Acta Anaesthesiol Scand 2009, 53:280-288.
• [11]Nielsen N, Friberg H, Gluud C, Herlitz J, Wetterslev J: Hypothermia after cardiac arrest should be further evaluated - a systematic review of randomised trials with meta-analysis and trial sequential analysis. Int J Cardiol 2011, 151:333-341.
• [12]Dragancea I, Rundgren M, Englund E, Friberg H, Cronberg T: The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest. Resuscitation 2013, 84:337-342.
• [13]Laver S, Farrow C, Turner D, Nolan J: Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med 2004, 30:2126-2128.
• [14]Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M, Gabrielli A, Silvers SM, Zaritsky AL, Merchant R, et al.: Part 9: post-cardiac arrest care: 2010 american heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010, 122:S768-S786.
• [15]Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S: Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the quality standards subcommittee of the american academy of neurology. Neurology 2006, 67:203-210.
• [16]Cronberg T, Brizzi M, Liedholm L, Rosén I, Rubertsson S, Rylander C, Friberg H: Neurological prognostication after cardiac arrest – recommendations from the swedish resuscitation council. Resuscitation 2013, 84:867-872.
• [17]Al Thenayan E, Savard M, Sharpe M, Norton L, Young B: Predictors of poor neurologic outcome after induced mild hypothermia following cardiac arrest. Neurology 2008, 71:1535-1537.
• [18]Fugate JE, Wijdicks EF, Mandrekar J, Claassen DO, Manno EM, White RD, Bell MR, Rabinstein AA: Predictors of neurologic outcome in hypothermia after cardiac arrest. Ann Neurol 2010, 68:907-914.
• [19]Bouwes A, Binnekade JM, Kuiper MA, Bosch FH, Zandstra DF, Toornvliet AC, Biemond HS, Kors BM, Koelman JH, Verbeek MM, et al.: Prognosis of coma after therapeutic hypothermia: a prospective cohort study. Ann Neurol 2012, 71:206-212.
• [20]Rossetti AO, Oddo M, Logroscino G, Kaplan PW: Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol 2010, 67:301-307.
• [21]Cronberg T, Rundgren M, Westhall E, Englund E, Siemund R, Rosen I, Widner H, Friberg H: Neuron-specific enolase correlates with other prognostic markers after cardiac arrest. Neurology 2011, 77:623-630.
• [22]Samaniego EA, Mlynash M, Caulfield AF, Eyngorn I, Wijman CA: Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia. Neurocrit Care 2011, 15:113-119.
• [23]Zandbergen EG, Hijdra A, Koelman JH, Hart AA, Vos PE, Verbeek MM, de Haan RJ: Prediction of poor outcome within the first 3 days of postanoxic coma. Neurology 2006, 66:62-68.
• [24]Tømte O, Andersen GO, Jacobsen D, Draegni T, Auestad B, Sunde K: Strong and weak aspects of an established post-resuscitation treatment protocol-a five-year observational study. Resuscitation 2011, 82:1186-1193.
• [25]Schefold JC, Storm C, Kruger A, Ploner CJ, Hasper D: The glasgow coma score is a predictor of good outcome in cardiac arrest patients treated with therapeutic hypothermia. Resuscitation 2009, 80:658-661.
• [26]Edgren E, Hedstrand U, Kelsey S, Sutton-Tyrrell K, Safar P: Assessment of neurological prognosis in comatose survivors of cardiac arrest. BRCT I Study Group. Lancet 1994, 343:1055-1059.
• [27]Jørgensen EO, Holm S: The natural course of neurological recovery following cardiopulmonary resuscitation. Resuscitation 1998, 36:111-122.
• [28]Tortorici MA, Kochanek PM, Poloyac SM: Effects of hypothermia on drug disposition, metabolism, and response: a focus of hypothermia-mediated alterations on the cytochrome P450 enzyme system. Crit Care Med 2007, 35:2196-2204.
• [29]Bjelland TW, Klepstad P, Haugen BO, Nilsen T, Dale O: Effects of hypothermia on the disposition of morphine, midazolam, fentanyl, and propofol in intensive care unit patients. Drug Metab Dispos 2013, 41:214-223.
• [30]Zandbergen EG, de Haan RJ, Stoutenbeek CP, Koelman JH, Hijdra A: Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet 1998, 352:1808-1812.
• [31]Leithner C, Ploner CJ, Hasper D, Storm C: Does hypothermia influence the predictive value of bilateral absent N20 after cardiac arrest? Neurology 2010, 74:965-969.
• [32]Zandbergen EG, Hijdra A, de Haan RJ, van Dijk JG, de Visser BW O, Spaans F, Tavy DL, Koelman JH: Interobserver variation in the interpretation of SSEPs in anoxic-ischaemic coma. Clin Neurophysiol 2006, 117:1529-1535.
• [33]Rossetti AO, Oddo M, Liaudet L, Kaplan PW: Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology 2009, 72:744-749.
• [34]Wijdicks EF, Parisi JE, Sharbrough FW: Prognostic value of myoclonus status in comatose survivors of cardiac arrest. Ann Neurol 1994, 35:239-243.
• [35]Lucas JM, Cocchi MN, Salciccioli J, Stanbridge JA, Geocadin RG, Herman ST, Donnino MW: Neurologic recovery after therapeutic hypothermia in patients with post-cardiac arrest myoclonus. Resuscitation 2012, 83:265-269.
• [36]Webb AC, Samuels OB: Reversible brain death after cardiopulmonary arrest and induced hypothermia. Crit Care Med 2011, 39:1538-1542.
• [37]Brct I, Study group: Randomized clinical study of thiopental loading in comatose survivors of cardiac arrest. N Engl J Med 1986, 314:397-403.
• [38]Brct II, Study group: A randomized clinical study of a calcium-entry blocker (lidoflazine) in the treatment of comatose survivors of cardiac arrest. N Engl J Med 1991, 324:1225-1231.
• [39]Geocadin RG, Peberdy MA, Lazar RM: Poor survival after cardiac arrest resuscitation: a self-fulfilling prophecy or biologic destiny? Crit Care Med 2012, 40:979-980.
• [40]Laurent I, Adrie C, Vinsonneau C, Cariou A, Chiche JD, Ohanessian A, Spaulding C, Carli P, Dhainaut JF, Monchi M: High-volume hemofiltration after out-of-hospital cardiac arrest: a randomized study. J Am Coll Cardiol 2005, 46:432-437.
• [41]Nielsen N, Wetterslev J, Al-Subaie N, Andersson B, Bro-Jeppesen J, Bishop G, Brunetti I, Cranshaw J, Cronberg T, Edqvist K, et al.: Target temperature management after out-of-hospital cardiac arrest-a randomized, parallel-group, assessor-blinded clinical trial-rationale and design. Am Heart J 2012, 163:541-548.
• [42]Fugate JE, Wijdicks EF, White RD, Rabinstein AA: Does therapeutic hypothermia affect time to awakening in cardiac arrest survivors? Neurology 2011, 77:1346-1350.
• [43]Morris HR, Howard RS, Brown P: Early myoclonic status and outcome after cardiorespiratory arrest. J Neurol Neurosurg Psychiatry 1998, 64:267-268.
• [44]Perman SM, Kirkpatrick JN, Reitsma AM, Gaieski DF, Lau B, Smith TM, Leary M, Fuchs BD, Levine JM, Abella BS, et al.: Timing of neuroprognostication in postcardiac arrest therapeutic hypothermia. Crit Care Med 2012, 40:719-724.
• [45]Busch M, Søreide E: Prognostication after out-of-hospital cardiac arrest, a clinical survey. Scand J Trauma Resusc Emerg Med 2008, 16:9. BioMed Central Full Text
• [46]Blondin NA, Greer DM: Neurologic prognosis in cardiac arrest patients treated with therapeutic hypothermia. Neurologist 2011, 17:241-248.
• [47]Friberg H, Rundgren M, Westhall E, Nielsen N, Cronberg T: Continuous evaluation of neurological prognosis after cardiac arrest. Acta Anaesthesiol Scand 2013, 57:6-15.
• [48]Oddo M, Rossetti AO: Predicting neurological outcome after cardiac arrest. Curr Opin Crit Care 2011, 17:254-259.
• [49]Samaniego EA, Persoon S, Wijman CA: Prognosis after cardiac arrest and hypothermia: a new paradigm. Curr Neurol Neurosci Rep 2011, 11:111-119.