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



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).



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).



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.
Service de Neurologie, University Hospital and Faculty of Biology and Medicine, Lausanne, Switzerland.
Spyridoula
0000-0003-4521-5745
S
Tsetsou
Service de Neurologie, University Hospital and Faculty of Biology and Medicine, Lausanne, Switzerland.
Jan
J
Novy
Laboratoire de Recherche en Neuroimagerie (LREN), University Hospital and Faculty of Biology and Medicine, Lausanne, Switzerland.
Christian
C
Pfeiffer
Service de Médecine Intensive Adulte, University Hospital and Faculty of Biology and Medicine, Lausanne, Switzerland.
Mauro
M
Oddo
Service de Neurologie, University Hospital and Faculty of Biology and Medicine, Lausanne, Switzerland. andrea.rossetti@chuv.ch.
Andrea O
AO
Rossetti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011379:Prognosis
D010751:Phosphopyruvate Hydratase
Cardiac arrest; Electroencephalogram; Prognostication