Evidence map›Paper›PMID 32915254›Full record

SynthesisIntensive care medicine2020

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review.

Claudio Sandroni, Sonia D'Arrigo, Sofia Cacciola, Cornelia W E Hoedemaekers, Marlijn J A Kamps, Mauro Oddo, Fabio S Taccone, Arianna Di Rocco, Frederick J A Meijer, Erik Westhall and 4 more

Open access · hybridAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 165 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
165citing papers in PubMed, 12 pooled it
41.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

165 citing papers in PubMed, 12 syntheses or guidelines pooled it, 335 citations in OpenAlex.

  1. Guideline
  2. Guideline
  3. Care pathways for individuals with post-anoxic disorder of consciousness (CaPIADoC): an inter-society Consensus Conference.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
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  9. Temperature control after cardiac arrest.Critical care (London, England) · 2022
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105 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 8 institutions in 6 countries.

Claudio SandroniDepartment of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.
Sonia D'ArrigoDepartment of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy. sonia.darrigo@policlinicogemelli.it.ORCID http://orcid.org/0000-0001-6740-3195
Sofia CacciolaDepartment of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.
Cornelia W E HoedemaekersDepartment of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Marlijn J A KampsIntensive Care Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Mauro OddoDepartment of Intensive Care Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland.
Fabio S TacconeDepartment of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Arianna Di RoccoDepartment of Public Health and Infectious Disease, Sapienza University, Rome, Italy.
Frederick J A MeijerDepartment of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Erik WesthallDepartment of ClinicalSciences, Clinical Neurophysiology, Lund University, Skane University Hospital, Lund, Sweden.
Massimo AntonelliDepartment of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.
Jasmeet SoarCritical Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
Jerry P Nolan *Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
Tobias Cronberg *Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden.
Radboud University Nijmegen · NLAgostino Gemelli University Polyclinic · ITLund University · SEUniversità Cattolica del Sacro Cuore · ITNorth Bristol NHS Trust · GBRoyal United Hospital · GBUniversité Libre de Bruxelles · BEUniversity of Lausanne · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA).

methodsPubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed.

resultsNinety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors.

conclusionIn comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169).

Indexed as

Heart ArrestHypothermia, InducedAdultComaEvoked Potentials, SomatosensoryHumansPrognosisSurvivorsCardiac arrestClinical examinationComaComputed tomographyDiffusion magnetic resonance imagingNeuron-specific enolasePrognosisSomatosensory-evoked potentials

Identifiers

PMID32915254
PMCPMC7527362
OpenAlexW3085509199

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.