Article

The accurate prediction of outcome after out-of-hospital cardiac
arrest (OHCA) is of major importance. The recently described Full Outline of
UnResponsiveness (FOUR) is well adapted to mechanically ventilated patients and
does not depend on verbal response. OBJECTIVE: To evaluate the ability of FOUR
assessed by intensivists to accurately predict outcome in OHCA. METHODS: We
prospectively identified patients admitted for OHCA with a Glasgow Coma Scale
below 8. Neurological assessment was performed daily. Outcome was evaluated at
6months using Glasgow-Pittsburgh Cerebral Performance Categories (GP-CPC).
RESULTS: Eighty-five patients were included. At 6months, 19 patients (22%) had a
favorable outcome, GP-CPC 1-2, and 66 (78%) had an unfavorable outcome, GP-CPC
3-5. Compared to both brainstem responses at day 3 and evolution of Glasgow Coma
Scale, evolution of FOUR score over the three first days was able to predict
unfavorable outcome more precisely. Thus, absence of improvement or worsening
from day 1 to day 3 of FOUR had 0.88 (0.79-0.97) specificity, 0.71 (0.66-0.76)
sensitivity, 0.94 (0.84-1.00) PPV and 0.54 (0.49-0.59) NPV to predict unfavorable
outcome. Similarly, the brainstem response of FOUR score at 0 evaluated at day 3
had 0.94 (0.89-0.99) specificity, 0.60 (0.50-0.70) sensitivity, 0.96 (0.92-1.00)
PPV and 0.47 (0.37-0.57) NPV to predict unfavorable outcome. CONCLUSION: The
absence of improvement or worsening from day 1 to day 3 of FOUR evaluated by
intensivists provides an accurate prognosis of poor neurological outcome in OHCA.
CI - Copyright (c) 2015 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS