To assess the ability of clinical examination, biomarkers, electrophysiology and brain imaging, individually or in combination to predict good neurological outcomes at 6 months after CA. This was a retrospective analysis of the Korean Hypothermia Network Prospective Registry 1.0, which included adult out-of-hospital cardiac arrest (OHCA) patients (≥18 years). Good outcome predictors were defined as both pupillary light reflex (PLR) and corneal reflex (CR) at admission, Glasgow Coma Scale Motor score (GCS-M) >3 at admission, neuron-specific enolase (NSE) <17 µg/L at 24–72 h, a median nerve somatosensory evoked potential (SSEP) N20/P25 amplitude >4 µV, continuous background without discharges on electroencephalogram (EEG), and absence of anoxic injury on brain CT and diffusion-weighted imaging (DWI). A total of 1327 subjects were included in the final analysis, and their median age was 59 years; among them, 412 subjects had a good neurological outcome at 6 months. GCS-M >3 at admission had the highest specificity of 96.7% (95% CI 95.3–97.8), and normal brain DWI had the highest sensitivity of 96.3% (95% CI 92.9–98.4). When the two predictors were combined, the sensitivities tended to decrease (ranging from 2.7–81.1%), and the specificities tended to increase, ranging from81.3–100%. Through the explorative variation of the 2021 European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) prognostication strategy algorithms, good outcomes were predicted, with a specificity of 83.2% and a sensitivity of 83.5% in patients by the algorithm. Clinical examination, biomarker, electrophysiology, and brain imaging predicted good outcomes at 6 months after CA. When the two predictors were combined, the specificity further improved. With the 2021 ERC/ESICM guidelines, the number of indeterminate patients and the uncertainty of prognostication can be reduced by using a good outcome prediction algorithm.

中文翻译：

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院外心脏骤停后良好的预后预测：韩国的一项前瞻性多中心观察研究（KORHN-PRO 注册中心）


旨在评估临床检查、生物标志物、电生理学和脑成像单独或组合预测 CA 后 6 个月良好神经系统结果的能力。这是对韩国低温网络前瞻性注册 1.0 的回顾性分析，其中包括成人院外心脏骤停 (OHCA) 患者（≥18 岁）。良好的结果预测因子被定义为入院时瞳孔对光反射 (PLR) 和角膜反射 (CR)、入院时格拉斯哥昏迷量表运动评分 (GCS-M) >3、入院时神经元特异性烯醇化酶 (NSE) <17 µg/L 24-72小时，正中神经体感诱发电位（SSEP）N20/P25振幅>4μV，脑电图（EEG）连续背景无放电，脑CT和弥散加权成像（DWI）无缺氧损伤。最终分析共纳入 1327 名受试者，中位年龄为 59 岁；其中，412 名受试者在 6 个月时神经系统结果良好。入院时 GCS-M >3 的特异性最高，为 96.7% (95% CI 95.3–97.8)，正常脑 DWI 的敏感性最高，为 96.3% (95% CI 92.9–98.4)。当两个预测因子结合时，敏感性趋于下降（范围为2.7-81.1%），特异性趋于增加，范围为81.3-100%。通过对2021年欧洲复苏委员会（ERC）和欧洲重症监护医学会（ESICM）预测策略算法的探索性变化，预测了良好的结果，该算法对患者的特异性为83.2%，敏感性为83.5% 。临床检查、生物标志物、电生理学和脑成像预测 CA 后 6 个月有良好的结果。当两个预测因子结合起来时，特异性进一步提高。 根据 2021 年 ERC/ESICM 指南，可以通过使用良好的结果预测算法来减少不确定患者的数量和预后的不确定性。