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Published on: April 14, 2023
Multimodal Neuroprognostication of Poor Neurological Outcomes after Cardiac Arrest: A Systematic Review
Alexandra Barriault1, Caralyn Bencsik2, Andrea Soo2
1Department of Cardiology and Critical Care Medicine, Laval University, IUCPQ-Heart and Lung Institute, Quebec City, Canada.
Background:
Brain injury related to hypoxic-ischemic insults post-cardiac arrest is a highly morbid and often fatal condition for which neuroprognostication remains challenging. There has been a significant increase in studies assessing the accuracy of multimodal approaches in predicting poor neurological outcomes post-cardiac arrest, and contemporary guidelines recommend this approach. We conducted a systematic review to assess multimodal versus unimodal approaches in neuroprognostication for predicting a poor neurological outcome for adult post-cardiac arrest patients at hospital discharge or beyond.
Methods:
PRISMA methodological standards were followed. MEDLINE, EMBASE and CINAHL were searched from inception until January 18, 2024, with no restrictions. Abstract and full-text review was completed in duplicate. Original studies assessing the prognostic accuracy (specificity and false positive rate [FPR]) of multimodal compared with unimodal approaches were included. The risk of bias was assessed using the QUIPS tool. Data were extracted in duplicate.
Results:
Of 791 abstracts, 12 studies were included. The FPR in predicting poor neurological outcomes ranged from 0% to 5% using a multimodal approach compared to 0% to 31% with a unimodal test. The risk of bias was moderate to high for most components.
Conclusions:
A multimodal approach may improve the FPR in predicting poor neurological outcomes of post-cardiac arrest patients.
