Does a combination of ≥2 abnormal tests vs. the ERC-ESICM stepwise algorithm improve prediction of poor neurological outcome after cardiac arrest? A post-hoc analysis of the ProNeCA multicentre study

BackgroundBilaterally absent pupillary light reflexes (PLR) or N20 waves of short-latency evoked potentials (SSEPs) are recommended by the 2015 ERC-ESICM guidelines as robust, first-line predictors poor neurological outcome after cardiac arrest. However, recent evidence shows that false positive rates (FPRs) these tests may be higher than previously reported. We investigated if testing accuracy is improved when combining PLR/SSEPs with malignant electroencephalogram (EEG), oedema on brain computed tomography (CT), early status myoclonus (SM).MethodsPost-hoc analysis ProNeCA multicentre prognostication study. compared prognostic strategy vs. a new ≥2 abnormal results from any PLR, SSEPs, EEG, CT and SM. also using alternative classifications for SSEPs (absent-pathological bilaterally-absent N20) EEG (ACNS-defined suppression burst-suppression unreactive epilepticus) test sensitivity.ResultsWe assessed 210 adult comatose resuscitated patients whom 164 (78%) had (CPC 3–5) at six months. FPRs sensitivities algorithm were 0[0−8]% 7 [1–18]% 49[41−57]% 63[56−71]%, respectively (p < .0001). Using SSEP/EEG definitions increased number concordant sensitivity both strategies (67[59−74]% 54[46−61]% respectively), no loss specificity.ConclusionsIn patients, among SM was more specific predicting 6-month outcome.