ArticleCureus2026
Impact of the 2021 European Resuscitation Council-European Society of Intensive Care Medicine (ERC-ESICM) Guidelines on Neuroprognostication Practices After Cardiac Arrest: A Five-Year Cohort Study.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Outcomes and Decision-Making Following Out-of-Hospital Cardiac Arrest Within a Multidisciplinary Neuroprognostication Pathway in a Tertiary Cardiac Intensive Care Unit.Journal of clinical medicine · 2026Article
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4 authors.
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Abstract
backgroundAccurate neuroprognostication after cardiac arrest (CA) is essential to avoid premature withdrawal of life-sustaining measures (WLSM). The 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC-ESICM) guidelines strengthened multimodal prognostication, but real adherence and its relationship with clinical outcomes remain insufficiently evaluated.
methodsWe conducted a retrospective cohort study of adult CA patients admitted to the Intensive Care Unit (ICU) between 2018 and 2022. Adherence to seven guideline-based neuroprognostication parameters was quantified through a composite adherence score (0-7). Cohorts were compared before (pre-guidelines) and after (post-guidelines) March 2021. Temporal trends were examined from 2018 to 2022. Associations between adherence and four clinical outcomes (WLSM ≥ 72 hours, overall WLSM, ICU mortality, and six-month mortality) were assessed using Mann-Whitney U tests and rank-biserial correlations.
resultsA total of 301 patients were included (pre-guidelines: 200; post-guidelines: 101). Neuron-specific enolase (NSE) measurement increased markedly after guideline publication (1% vs. 34.6%, p < 0.01), whereas adherence to somatosensory evoked potentials (SSEP), electroencephalogram (EEG), neuroimaging, neuroprognostication ≥ 72 hours, and deferred WLSM ≥ 72 hours did not differ significantly between cohorts. The composite adherence score increased from 3 (1-4) to 4 (1-5) (p = 0.056). Across 2018-2022, mean adherence demonstrated a gradual upward trend, with the sharpest rise after 2021. Individual parameter trends were heterogeneous, with significant post-guideline increases only in NSE use. Higher adherence scores were significantly associated with WLSM ≥ 72 hours, overall WLSM, and lower ICU and six-month mortality (all p < 0.05). Rank-biserial correlations showed moderate positive associations with WLSM variables and moderate negative associations with mortality outcomes.
conclusionsImplementation of the 2021 ERC-ESICM guidelines was associated with increased overall adherence, primarily driven by NSE measurement. Higher adherence correlated with more guideline-concordant timing of WLSM and improved survival outcomes. Strengthening multimodal prognostication practice may further reduce variability and prevent premature care limitation.
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