• Resuscitation · Oct 2020

    Optimal combination of clinical examinations for neurologic prognostication of out-of-hospital cardiac arrest patients.

    • Ji Hoon Kim, Incheol Park, Sung Phil Chung, Ha Yan Kim, In Kyung Min, Su Jin Kim, Soo Hyun Kim, Jae Hoon Lee, Hyung Jun Moon, Yoo Seok Park, and Korean Hypothermia Network Investigators.
    • Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul-03722, Republic of Korea.
    • Resuscitation. 2020 Oct 1; 155: 91-99.

    AimTargeted temperature management (TTM) may alter the results of clinical examination and delay motor response recovery; hence, re-establishing the accuracy and optimal timing of performing clinical examinations are crucial. Therefore, we aimed to identify the optimal combination and timing of clinical examinations for predicting the neurologic outcomes in patients undergoing TTM.MethodsWe conducted a retrospective analysis of prospectively collected multicentre registry data. All enrolled patients were supposed to undergo pupil light reflex (PLR), corneal reflex (CR), and Glasgow Coma Scale for 7 days after return of spontaneous circulation (ROSC). We investigated the timing of each examination based on the ROSC and rewarming completion times. The primary outcome was poor neurologic outcome (cerebral performance category 3,4, or 5) at 6 months after cardiac arrest.ResultsA total of 715 patients treated with TTM within 2 years, were enrolled. The PLR is more specific than the other examinations, and the specificity of the combination of PLR with CR was 100% 72 h after the ROSC or 24 h after rewarming completion. The sensitivity for the combination of PLR with CR 72 h after the ROSC was 55.3 (49.8-60.7) %, which was not different from that noted 24 h after rewarming completion (P = 0.65).ConclusionThe combination of PLR with CR showed specificity approaching 100% 72 h after the ROSC or 24 h after rewarming completion. These findings can provide a clinical reference for predicting the neurological outcomes in patients undergoing TTM, especially in institutions without up-to-date facilities.Copyright © 2020 Elsevier B.V. All rights reserved.

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