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Multimodal Neuroprognostication of Poor Neurological Outcomes after Cardiac Arrest: A Systematic Review

Published online by Cambridge University Press:  23 May 2025

Alexandra Barriault Open the ORCID record for Alexandra Barriault [Opens in a new window] ,
Caralyn Bencsik Open the ORCID record for Caralyn Bencsik [Opens in a new window] ,
Andrea Soo ,
Andreas Kramer  and
Julie Kromm
Alexandra Barriault*
Affiliation:
Department of Cardiology and Critical Care Medicine, Laval University, IUCPQ-Heart and Lung Institute, Quebec City, Canada
Caralyn Bencsik
Affiliation:
Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
Andrea Soo
Affiliation:
Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
Andreas Kramer
Affiliation:
Department of Critical Care Medicine & Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, Canada Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Julie Kromm
Affiliation:
Department of Critical Care Medicine & Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
*
Corresponding author: Alexandra Barriault; Email: alexandra.barriault.1@ulaval.ca
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Abstract:

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.

Résumé :

RÉSUMÉ :

Le pronostic neurologique multimodal d’une évolution défavorable des patients après un arrêt cardiaque : une revue systématique.

Contexte :

Les lésions cérébrales liées à l’hypoxie et à l’ischémie après un arrêt cardiaque constituent des dommages associés à une grande morbidité et souvent mortels pour lesquels un pronostic de type neurologique reste difficile à établir. À cet égard, il y a eu une augmentation significative des études évaluant, d’une part, la précision des approches multimodales dans la prédiction de l’évolution neurologique des patients après un arrêt cardiaque et, d’autre part, les lignes directrices contemporaines recommandant cette approche. Nous avons ainsi effectué une revue systématique pour évaluer les approches multimodales par rapport aux approches unimodales dans le cas de pronostics neurologiques permettant de prédire une évolution défavorable chez des patients adultes victimes d’un arrêt cardiaque au moment de leur congé de l’hôpital ou par la suite.

Méthodes :

Les normes méthodologiques PRISMA ont été suivies. Des recherches ont été effectuées dans Medline, Embase et CINAHL depuis les débuts de l’étude jusqu’au 18 janvier 2024, et ce, sans aucune restriction. Les résumés et les textes intégraux ont été examinés en double. Des études originales évaluant la précision pronostique (spécificité et taux de faux positifs) des approches multimodales par rapport aux approches unimodales ont été incluses. Le risque de biais a été évalué à l’aide de l’outil QUIPS. De plus, les données ont été extraites en double.

Résultats :

Sur 791 résumés, 12 études ont été incluses. Le taux de faux positifs dans la prédiction d’une évolution neurologique défavorable variait de 0 à 5 % en utilisant une approche multimodale contre 0 à 31 % au moyen d’une approche unimodale. Précisons que le risque de biais était modéré à élevé pour la plupart des composants.

Conclusions :

Une approche multimodale peut améliorer le taux de faux positifs dans la prédiction d’une évolution neurologique défavorable chez les patients victimes d’un arrêt cardiaque.

Keywords

Neuroprognosticationpost-cardiac arrestpoor neurological outcomesmultimodaladult patients
Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 17
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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