David Filgueiras-Rama1, Conrado J Calvo2, Óscar Salvador-Montañés3, Rosalía Cádenas3, Jose Ruiz-Cantador3, Eduardo Armada3, Juan Ramón Rey3, J L Merino3, Rafael Peinado3, Nicasio Pérez-Castellano4, Julián Pérez-Villacastín4, Jorge G Quintanilla5, Santiago Jiménez6, Francisco Castells2, Francisco J Chorro7, J L López-Sendón3, Omer Berenfeld8, José Jalife9, Esteban López de Sá3, José Millet2. 1. Atherothrombosis, Imaging and Epidemiology Department, Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Hospital Clínico San Carlos, Madrid, Spain; Hospital Universitario La Paz, IdiPaz, Madrid, Spain. Electronic address: david.filgueiras@cnic.es. 2. Bio-ITACA Grupo de Bioingeniería, Instituto de Aplicaciones Avanzadas, Dpto Ingeniería Electrónica, Universitat Politècnica de Valencia, Spain; Grupo Electrofisiología y Bioingeniería, Microcluster en Protección Cardiovascular, Dpto de Medicina, Fundación INCLIVA Hospital Clínico, Valencia, Spain. 3. Hospital Universitario La Paz, IdiPaz, Madrid, Spain. 4. Hospital Clínico San Carlos, Madrid, Spain. 5. Atherothrombosis, Imaging and Epidemiology Department, Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. 6. Bio-ITACA Grupo de Bioingeniería, Instituto de Aplicaciones Avanzadas, Dpto Ingeniería Electrónica, Universitat Politècnica de Valencia, Spain. 7. Grupo Electrofisiología y Bioingeniería, Microcluster en Protección Cardiovascular, Dpto de Medicina, Fundación INCLIVA Hospital Clínico, Valencia, Spain. 8. Center for Arrhythmia Research, Cardiovascular Research Center, Department of Internal Medicine, University of MI, Ann Arbor, USA. 9. Atherothrombosis, Imaging and Epidemiology Department, Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Center for Arrhythmia Research, Cardiovascular Research Center, Department of Internal Medicine, University of MI, Ann Arbor, USA.
Abstract
BACKGROUND: Early prognosis in comatose survivors after cardiac arrest due to ventricular fibrillation (VF) is unreliable, especially in patients undergoing mild hypothermia. We aimed at developing a reliable risk-score to enable early prediction of cerebral performance and survival. METHODS: Sixty-one out of 239 consecutive patients undergoing mild hypothermia after cardiac arrest, with eventual return of spontaneous circulation (ROSC), and comatose status on admission fulfilled the inclusion criteria. Background clinical variables, VF time and frequency domain fundamental variables were considered. The primary and secondary outcomes were a favorable neurological performance (FNP) during hospitalization and survival to hospital discharge, respectively. The predictive model was developed in a retrospective cohort (n = 32; September 2006-September 2011, 48.5 ± 10.5 months of follow-up) and further validated in a prospective cohort (n = 29; October 2011-July 2013, 5 ± 1.8 months of follow-up). RESULTS: FNP was present in 16 (50.0%) and 21 patients (72.4%) in the retrospective and prospective cohorts, respectively. Seventeen (53.1%) and 21 patients (72.4%), respectively, survived to hospital discharge. Both outcomes were significantly associated (p < 0.001). Retrospective multivariate analysis provided a prediction model (sensitivity = 0.94, specificity = 1) that included spectral dominant frequency, derived power density and peak ratios between high and low frequency bands, and the number of shocks delivered before ROSC. Validation on the prospective cohort showed sensitivity = 0.88 and specificity = 0.91. A model-derived risk-score properly predicted 93% of FNP. Testing the model on follow-up showed a c-statistic ≥ 0.89. CONCLUSIONS: A spectral analysis-based model reliably correlates time-dependent VF spectral changes with acute cerebral injury in comatose survivors undergoing mild hypothermia after cardiac arrest.
BACKGROUND: Early prognosis in comatose survivors after cardiac arrest due to ventricular fibrillation (VF) is unreliable, especially in patients undergoing mild hypothermia. We aimed at developing a reliable risk-score to enable early prediction of cerebral performance and survival. METHODS: Sixty-one out of 239 consecutive patients undergoing mild hypothermia after cardiac arrest, with eventual return of spontaneous circulation (ROSC), and comatose status on admission fulfilled the inclusion criteria. Background clinical variables, VF time and frequency domain fundamental variables were considered. The primary and secondary outcomes were a favorable neurological performance (FNP) during hospitalization and survival to hospital discharge, respectively. The predictive model was developed in a retrospective cohort (n = 32; September 2006-September 2011, 48.5 ± 10.5 months of follow-up) and further validated in a prospective cohort (n = 29; October 2011-July 2013, 5 ± 1.8 months of follow-up). RESULTS: FNP was present in 16 (50.0%) and 21 patients (72.4%) in the retrospective and prospective cohorts, respectively. Seventeen (53.1%) and 21 patients (72.4%), respectively, survived to hospital discharge. Both outcomes were significantly associated (p < 0.001). Retrospective multivariate analysis provided a prediction model (sensitivity = 0.94, specificity = 1) that included spectral dominant frequency, derived power density and peak ratios between high and low frequency bands, and the number of shocks delivered before ROSC. Validation on the prospective cohort showed sensitivity = 0.88 and specificity = 0.91. A model-derived risk-score properly predicted 93% of FNP. Testing the model on follow-up showed a c-statistic ≥ 0.89. CONCLUSIONS: A spectral analysis-based model reliably correlates time-dependent VF spectral changes with acute cerebral injury in comatose survivors undergoing mild hypothermia after cardiac arrest.
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