Lagebrant Alice, Sandroni Claudio, Nolan Jerry P, Bělohlávek Jan, Cariou Alain, Carrai Riccardo, Dankiewicz Josef, Grejs Anders Morten, Grippo Antonello, Hassager Christian, Horn Janneke, Haenggi Matthias, Jakobsen Janus C, Keeble Thomas R, Kirkegaard Hans, Kjaergaard Jesper, Kuiper Michael A, Lee Byung Kook, Lee Dong Hun, Levin Helena, Lilja Gisela, Lundin Andreas, Nielsen Niklas, Oh Sang Hoon, Park Kyu Nam, Pellis Tommaso, Robba Chiara, Rylander Christian, Ryu Seok Jin, Saxena Manoxj, Scarpino Maenia, Schrag Claudia, Stammet Pascal, Storm Christian, Taccone Fabio Silvio, Thomas Matthew, Westhall Erik, Wise Matt P, Youn Chun Song, Young Paul, Cronberg Tobias, Moseby-Knappe Marion
Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital, Malmö, Sweden.
Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Largo Francesco Vito, 1, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
Resuscitation. 2025 Sep;214:110686. doi: 10.1016/j.resuscitation.2025.110686. Epub 2025 Jun 16.
To explore modifications of the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guideline algorithm for neuroprognostication after cardiac arrest to improve its prognostic accuracy.
Post-hoc analysis of four prospective multicentre studies (TTM, TTM2, KORHN and ProNeCA). We raised the Glasgow Coma Scale motor (GCS-M) inclusion threshold at 72 h after cardiac arrest from the current GCS-M < 4 to GCS-M < 6 (all unconscious patients). Secondly, we included good outcome predictors (GCS-M 4-5, neuron-specific enolase < 17 µg/L, benign electroencephalography patterns ≤ 72 h post-arrest and normal magnetic resonance imaging at 72-168 h post-arrest) in the algorithm. Functional outcome was assessed dichotomously at six months, including modified Rankin Scale 0-3, Cerebral Performance Category 1-2 or Glasgow Outcome Scale 4-5 (no symptoms to moderate disability) as good outcome.
We analysed 3,388 patients, of whom 2,079 had GCS-M < 4 at ≥ 72 h. Of the 874 patients identified by the 2021 ERC/ESICM poor outcome criteria, 870 had poor functional outcome (specificity: 99.6% [95%CI 99.0-99.9]). Using the GCS-M < 6 threshold, 366 more patients entered the algorithm (N = 2,445). Seven more patients with poor outcomes were identified, with close to identical specificity. Good outcome predictors thereafter identified 673 patients with potential recovery, of whom 411 (61%) had a good functional outcome at six months. With the updated algorithm, the number of prognosticated patients with an indeterminate prognosis decreased from 1,205/2,079 (58%) to 891/2,445 (36%).
Raising the GCS-M inclusion threshold and adding favourable predictors to the 2021 ERC/ESICM prognostication algorithm reduced prognostic uncertainty without increasing falsely pessimistic predictions.
探索对2021年欧洲复苏委员会/欧洲重症监护医学学会（ERC/ESICM）心脏骤停后神经预后评估指南算法的修改，以提高其预后准确性。
对四项前瞻性多中心研究（TTM、TTM2、KORHN和ProNeCA）进行事后分析。我们将心脏骤停后72小时格拉斯哥昏迷量表运动评分（GCS-M）的纳入阈值从当前的GCS-M < 4提高到GCS-M < 6（所有昏迷患者）。其次，我们在算法中纳入了良好预后预测指标（GCS-M 4-5、神经元特异性烯醇化酶< 17 μg/L、心脏骤停后≤ 72小时脑电图模式正常以及心脏骤停后72-168小时磁共振成像正常）。在六个月时对功能结局进行二分法评估，包括改良Rankin量表0-3分、脑功能分类1-2级或格拉斯哥结局量表4-5分（无症状至中度残疾）作为良好结局。
我们分析了3388例患者，其中2079例在≥ 72小时时GCS-M < 4。根据2021年ERC/ESICM不良结局标准确定的874例患者中，870例功能结局不良（特异性：99.6% [95%CI 99.0-99.9]）。使用GCS-M < 6的阈值，又有366例患者进入算法（N = 2445）。又识别出7例结局不良的患者，特异性相近。此后，良好预后预测指标识别出673例有潜在恢复可能的患者，其中411例（61%）在六个月时功能结局良好。使用更新后的算法，预后不确定的预测患者数量从1205/2079（58%）降至891/2445（36%）。
提高GCS-M纳入阈值并在2021年ERC/ESICM预后评估算法中添加有利预测指标，可减少预后不确定性，且不会增加错误的悲观预测。
