Journal club

1
Journal club

• ?????????? ????
• 3?? ?? ?

2
Prognostication of neurologic outcome in cardiac
arrest patients after mild therapeutic
hypothermia

• a meta-analysis of the current literature

Intensive Care Med (2013) 3916711682 DOI
10.1007/s00134-013-3004-y
3
??introduction/??aim

• CPA???????????????????4????????????AAN(American
  academy of neurology)???
• ?clinical neurological examination
• (including corneal reflexes, pupillary reflexes
  and
• motor response)
• ?myoclonic status epilepticus
• ?somatosensory evoked potential (SSEP)
• ? neuron-specific enolase (NSE) serum levels

4

• ???????????2??????????????
• ?clinical neurological examination (including
• corneal reflexes, pupillary reflexes and motor
• response)
• ?somatosensory evoked potential (SSEP)
• ?????????????????????CPA??????????????????????????
  ?????????????????????????????????????
• ???????????????CPA????????????????????????????????
  ?????????????

5
??study selection

• ??(?????????????)
• 18??????
• ???????????????????
• ?????(??????)1224??????????????????

6
??outcome measures

• ?????????????????
• ???favourable?unfavourable????

unfavourable favourable
GOS 13 45
mRS 56 03
CPC scale 35 12
GOSGlasgow outcome scale mRSmodified Rankin
scale CPC scale cerebral performance category
scale
7
?? Glasgow Outcome ScaleGOS
GOS ??
1dead ??
2vegetative state ????
3severely disabled ???????????, ???????????.
4moderately disabled ?????????????????,??????????.
5good recovery ???????????????????????????.
Unfavour
Favour
8
modified Rankin scalemRS
? Rankin Scale ???????
0 ????????? ??????????????????????
1 ???????????????? ???????????? ???????????????????????????????????????????
2 ????? ????????????????????????????????????????? ????????????????????????????????????????
3 ?????? ?????????????????? ????????????????????????????????????????????????????
4 ?????????? ????????????????????????
5 ????? ??????????????????
6 ??
Favour
Unfavour
9
Cerebral Performance Categories Scale CPC
Scale
Favour
Unfavour
10
??statistical analysis

• ?????favourable?unfavourable?
• 22?????
• FPR(????) 1 specificity(???)???
• 95 confidence intervals (CI)???????? ?????
• ?????? Higgins I2????

11
??Result
Study characteristic
445????????? 10?????????
12
Total of included patients per study compared to
the included patients per test
13
Summary measures of sensitivity and false
positive rate
FPR????? 95CI???????? ?????? ????????????????? (?
????????GCS??)
14
Bilaterally absent SSEP 72hrs
????72h?Bilaterally absent? TPR?FPR Sensitivity
(95 CI) 0.50 (0.420.57) FPR (95 CI) 0.007
(0.0010.047) Higgins I2 0
15
GCS motor response
????72h? Gcs motor response 12 ?TPR ?FPR
Sensitivity (95 CI) 0.80 (0.630.91) FPR
(95 CI) 0.21 (0.080.43) Higgins I2 23
16
Bilaterally absent corneal reflexes
????72h?bilaterally absent corneal reflexes ?TPR
?FPR Sensitivity (95 CI) 0.32
(0.270.39) FPR (95 CI) 0.02
(0.0020.13) Higgins I2lt1
17
Bilaterally absent pupillary reactions
????72h?bilaterally absent pupillary
reflexes ?TPR ?FPR Sensitivity (95 CI) 0.22
(0.180.27) FPR (95 CI) 0.004
(0.0010.03) Higgins I2 0
18
Discussion

• GCS motor score?????????????????????????????
• ???????SSPE???????FPR???95CI????????????????????
• ?????????????????????????????

19
Discussion

• ??????????????????????????????????????????????????
  ?????????????????????????????
• ??????????????????????????????????????????????????
  ???????????????
• ????????????????????????????????????????????????
• ?????????????SSEP????????
• ???????????????????

20
Limitation

• ????????????????????????44?79? ????????
• ????????????????????????
• ?????????????6?????????????????
• ??????ILCOR???????????????????????????????????????
  ??????????????????????????????????????
• ??????????????????????????????????????????????????
  ?????

21
Conclusion

• ??????????????????????????? ??????????????????????
  ??????????????????
• GCS motor score???????????????????????????????????
  ??
• ?????SSEP??????????????????? ???????????
• ???????????72????????????????????????????????????
  ??????????????????????????????????