Predicting neurological outcome in adult patients with cardiac arrest: systematic review and meta-analysis of prediction model performance

Critical Care

Research

Kai Tisljar¹  Simon A. Amacher²  Raoul Sutter³  Stephan Marsch³  Sebastian Gross⁴  Chantal Bohren⁴  Katharina Beck⁴  René Blatter⁴  Christoph Becker⁵  Sabina Hunziker⁶  Matthias Briel⁷  Christian Appenzeller-Herzog⁸ 

[1] Intensive Care, University Hospital Basel, Basel, Switzerland;Intensive Care, University Hospital Basel, Basel, Switzerland;Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland;Intensive Care, University Hospital Basel, Basel, Switzerland;Medical Faculty, University of Basel, Basel, Switzerland;Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland;Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland;Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland;Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland;Medical Faculty, University of Basel, Basel, Switzerland;Meta-Research Centre, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland;Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Canada;Medical Faculty, University of Basel, Basel, Switzerland;University Medical Library, University of Basel, Basel, Switzerland;

关键词: Cardiac arrest;    CAHP;    OHCA;    GO-FAR;    Neurological outcome;    Prognostication;    Prediction model;   

DOI  :  10.1186/s13054-022-04263-y

 received in 2022-08-31, accepted in 2022-10-10,  发布年份 2022

来源: Springer

【 摘 要 】

This work aims to assess the performance of two post-arrest (out-of-hospital cardiac arrest, OHCA, and cardiac arrest hospital prognosis, CAHP) and one pre-arrest (good outcome following attempted resuscitation, GO-FAR) prediction model for the prognostication of neurological outcome after cardiac arrest in a systematic review and meta-analysis. A systematic search was conducted in Embase, Medline, and Web of Science Core Collection from November 2006 to December 2021, and by forward citation tracking of key score publications. The search identified 1′021 records, of which 25 studies with a total of 124′168 patients were included in the review. A random-effects meta-analysis of C-statistics and overall calibration (total observed vs. expected [O:E] ratio) was conducted. Discriminatory performance was good for the OHCA (summary C-statistic: 0.83 [95% CI 0.81–0.85], 16 cohorts) and CAHP score (summary C-statistic: 0.84 [95% CI 0.82–0.87], 14 cohorts) and acceptable for the GO-FAR score (summary C-statistic: 0.78 [95% CI 0.72–0.84], five cohorts). Overall calibration was good for the OHCA (total O:E ratio: 0.78 [95% CI 0.67–0.92], nine cohorts) and the CAHP score (total O:E ratio: 0.78 [95% CI 0.72–0.84], nine cohorts) with an overestimation of poor outcome. Overall calibration of the GO-FAR score was poor with an underestimation of good outcome (total O:E ratio: 1.62 [95% CI 1.28–2.04], five cohorts). Two post-arrest scores showed good prognostic accuracy for predicting neurological outcome after cardiac arrest and may support early discussions about goals-of-care and therapeutic planning on the intensive care unit. A pre-arrest score showed acceptable prognostic accuracy and may support code status discussions.Graphical Abstract

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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Fig. 1

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Fig. 4