scholarly journals Infrared pupillometry to help predict neurological outcome for patients achieving return of spontaneous circulation following cardiac arrest: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Alex Monk ◽  
Shashank Patil
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Objective Measure ◽  
Spontaneous Circulation ◽  
Neurological Injury ◽  
Return Of Spontaneous Circulation ◽  
Use Of Resources ◽  
Infrared Pupillometry ◽  
Poor Neurological Outcome

Abstract Background Despite advances in resuscitation care, mortality rates following cardiac arrest (CA) remain high. Between one-quarter (in-hospital CA) and two-thirds (out of hospital CA) of patients admitted comatose to intensive care die of neurological injury. Neuroprognostication determines an informed and timely withdrawal of life sustaining treatment (WLST), sparing the patient unnecessary suffering, alleviating family distress and allowing a more utilitarian use of resources. The latest Resuscitation Council UK (2015) guidance on post-resuscitation care provides the current multi-modal neuroprognostication strategy to predict neurological outcome. Its modalities include neurological examination, neurophysiological tests, biomarkers and radiology. Despite each of the current strategy’s predictive modalities exhibiting limitations, meta-analyses show that three, namely PLR (pupillary light reflex), CR (corneal reflex) and N20 SSEP (somatosensory-evoked potential), accurately predict poor neurological outcome with low false positive rates. However, the quality of evidence is low, reducing confidence in the strategy’s results. While infrared pupillometry (IRP) is not currently used as a prognostication modality, it can provide a quantitative and objective measure of pupillary size and PLR, giving a definitive view of the second and third cranial nerve activity, a predictor of neurological outcome. Methods The proposed study will test the hypothesis, “in those patients who remain comatose following return of spontaneous circulation (ROSC) after CA, IRP can be used early to help predict poor neurological outcome”. A comprehensive review of the evidence using a PRISMA-P (2015) compliant methodology will be underpinned by systematic searching of electronic databases and the two authors selecting and screening eligible studies using the Cochrane data extraction and assessment template. Randomised controlled trials and retrospective and prospective studies will be included, and the quality and strength of evidence will be assessed using the Grading  of Recommendation, Assessment and Evaluation (GRADE) approach. Discussion IRP requires rudimentary skill and is objective and repeatable. As a clinical prognostication modality, it may be utilised early, when the strategy’s other modalities are not recommended. Corroboration in the evidence would promote early use of IRP and a reduction in ICU bed days. Systematic review registration PROSPERO CRD42018118180

Cerebral oximetry and return of spontaneous circulation after cardiac arrest: A systematic review and meta-analysis

Resuscitation ◽  
2015 ◽  
Vol 94 ◽  
pp. 67-72 ◽  
Author(s):  
Filippo Sanfilippo ◽  
Giovanni Serena ◽  
Carlos Corredor ◽  
Umberto Benedetto ◽  
Marc O. Maybauer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
Cerebral Oximetry ◽  
Return Of Spontaneous Circulation

scholarly journals Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

2020 ◽  
Vol 46 (10) ◽  
pp. 1803-1851 ◽  
Author(s):  
Claudio Sandroni ◽  
Sonia D’Arrigo ◽  
Sofia Cacciola ◽  
Cornelia W. E. Hoedemaekers ◽  
Marlijn J. A. Kamps ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Poor Neurological Outcome

Abstract 315: Influence of Previous Comorbidities on Hospital Outcome After Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Florence Dumas ◽  
Audrey Paoli ◽  
Marine Paul ◽  
Jean-Francois Llitjos ◽  
Guillaume Savary ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
Multinomial Regression ◽  
Shockable Rhythm ◽  
Poor Neurological Outcome ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Comorbidity Index ◽  
Mode Of Death

Introduction: Despite improvements, overall survival after out-of-hospital cardiac arrest (OHCA) remains low, even in those with return of spontaneous circulation (ROSC). In addition to usual prognostic characteristics, patients’ medical history may also influence the outcome. This study aimed to investigate the role of comorbidities on hospital mortality, neurological outcome and mode of death in OHCA patients with successful ROSC. Methods: From Jan 2012 to Sep 2017, all consecutive non-traumatic OHCA adults with stable ROSC admitted in ICU were included. Utstein characteristics, circumstances and in-hospital interventions were prospectively recorded. Comorbidities were measured using Charlson Comorbidity Index (CCI), divided into 3 groups (CCI=0,CCI=1-3,CCI>3).The influence of CCI on mortality and poor neurological outcome at discharge (with a Cerebral Performance Categories level>2) was assessed using logistic regression and association with mode of death (withdrawal of life sustaining treatments (WLST) or other causes) using multinomial regression. Results: During the study period, among 777 patients admitted alive and analyzed, 504 (65%) pts were discharged as CPC>2 and 484 (62%) died in ICU with 48%, 61% and 70% in CCI-0, CCI 1-3 and CCI>3 respectively. After adjustment, an increase in CCI was associated with poor neurological outcome (ORadj 2.22 [1.21-4.08] for CCI=1-3 and ORadj=2.86 [1.50-5.45] for CCI>3; ref CCI=0). Other independent predictors were an initial non shockable rhythm (OR=3.70[2.38-5.88]), absence of bystander cardiopulmonary resuscitation (CPR) (OR=1.96[1.20-3.22]), higher dose of epinephrine (OR= 5.88 [3.70-9.09]), longer resuscitation (CA-CPR, OR=1.69 [1.10-2.63] and CPR-ROSC, OR=2.43 [1.56-3.85]). Using multinomial regression, an increased CCI was associated with all modes of death, but particularly with WLST (RRadj=2.43 [1.25-4.71] for CCI=1-3 and 4.27[2.15-8.48] for CCI>3, ref CCI=0). Conclusion: A high number of comorbidities, as assessed by CCI, was associated with a worse neurological and a higher mortality in patients admitted alive after cardiac arrest. Presence and burden of comorbidities should be considered in the evaluation of the prognosis in patients admitted after cardiac arrest

Abstract 132: Neurological Favorable Outcome Associated With Number of Prehospital Defibrillation Attempts in Out-of-Hospital Cardiac Arrest Without Return of Spontaneous Circulation on Scene

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Seulki Choi ◽  
Tae Han Kim ◽  
Ki Jeong Hong ◽  
Sung Wook Song ◽  
Joo Jeong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Life Support ◽  
Discharge Rate ◽  
Spontaneous Circulation ◽  
Successful Resuscitation ◽  
Return Of Spontaneous Circulation ◽  
Hospital Transport ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: The early and timely defibrillation in shockable rhythm of out-of-hospital cardiac arrest (OHCA) by prehospital EMS providers is crucial for successful resuscitation. In emergency medical service (EMS) system, where advanced cardiac life support could not be fully provided before hospital transport, optimal range of prehospital defibrillation attempts is debatable. We evaluated association between number of prehospital defibrillation attempts and survival outcomes in OHCA patients who were unresponsive to field resuscitation and defibrillations. Methods: This is a retrospective observational study using nationwide OHCA registry of Korea from 2013 to 2016. Adult EMS treated OHCA with presumed cardiac origin with shockable initial ECG rhythm were enrolled. Final analysis was performed in patients who did not achieve return of spontaneous circulation (ROSC) on scene before hospital transport. We categorized number of prehospital defibrillation attempt into 3 groups: ≤3 attempts, 4-5 attempts and ≥6 attempts. Primary outcome was favorable neurological outcome at hospital discharge. Multivariable logistic regression modeling was used to evaluate association between neurological outcome and defibrillation attempts. Result: Total 6,679 patients were enrolled for final analyzed. Among total ≤3 defibrillations were attempted in 5015 patients (75.1%), 1050 patients (15.7%) for 4-5 attempts, 614 patient. (9.2%) for ≥6 attempts. Although survival to discharge rate was highest in group with ≤3 defibrillation attempts (8.1% vs. 7.0% vs. 2.9%, p<0.01), survival rate with favorable neurological outcome was highest in group with 4-5 defibrillation attempts (3.0% vs. 4.5% vs. 2.1%, p=0.02). As 4-5 attempts group reference, adjusted odds ratio for favorable neurological outcome of ≤3 attempts was 0.66 (95% CI 0.46 - 0.94) and of ≥6 attempts was 0.47 (95% CI 0.25 - 0.89). Conclusion: For patients with shockable initial cardiac rhythm who were unresponsive to filed defibrillation and resuscitation, moderate amount of defibrillation attempt was associated with favorable neurological outcome compared to fewer defibrillation attempts and prolonged number of defibrillation attempts on scene.

Abstract 342: The Relationship Between Time Interval From Collapse to Return of Spontaneous Circulation After Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ken Nagao ◽  
Yoshio Tahara ◽  
Hiroshi Nonogi ◽  
Naohiro Yonemoto ◽  
David F Gaieski ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Time Interval ◽  
Return Of Spontaneous Circulation ◽  
Favorable Neurological Outcome ◽  
The Relationship ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Background: Early cardiopulmonary resuscitation (CPR) and early defibrillation are critical to survival from out-of-hospital cardiac arrest (OHCA). However, few studies have investigated the relationship between time interval from collapse to return of spontaneous circulation (ROSC) and neurologically intact survival. Methods: From the All-Japan OHCA Utstein Registry between 2005 and 2015, we enrolled adult patients achieving prehospital ROSC after witnessed OHCA, inclusive of arrest after emergency medical service responder arrival. The study patients were divided into two groups according to initial cardiac arrest rhythm (shockable versus non-shockable). The collapse-to-ROSC interval was calculated as the time interval from collapse to first achievement of prehospital ROSC. The primary endpoint was 30-day favorable neurological outcome after OHCA. Results: A total of 69,208 adult patients achieving prehospital ROSC after witnessed OHCA were enrolled; 23,017(33.3%) the shockable arrest group and 46,191 (66.7%) the non-shockable arrest group. The shockable arrest group compared with the non-shockable arrest group had significantly shorter collapse-to-ROSC interval (16±10 min vs. 20±13 min, P<0.001) and significantly higher frequency of the favorable neurological outcome (54.9% vs. 15.3%, P<0.001). Frequencies of the favorable neurological outcome after shockable OHCA decreased to 1.2% to 1.5% with every minute that the collapse-to-ROSC interval was delayed (78% at 1 minute of collapse, 68% at 10 minutes, 44% at 20 minutes, 34% at 30 minutes, 16% at 40 minutes, 4% at 50 minutes and 0% at 60 minutes, respectively, P<0.001), and those after non-shockable OHCA decreased to 0.8% to 1.8% with every minute that the collapse-to-ROSC interval was delayed (40% at 1 minute of collapse, 26% at 10 minutes, 11% at 20 minutes, 5% at 30 minutes, 2% at 40 minutes, 0% at 50 minutes and 0% at 60 minutes, respectively, P<0.001). Conclusions: Termination of the collapse-to-ROSC interval to achieve neurologically intact survival after witnessed OHCA was 50 minutes or longer irrespective of initial cardiac arrest rhythm (shockable versus non-shockable), although the neurologically intact survival rate was difference between the two groups.

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