To evaluate potential neuroprognosticators in patients with post-anoxic encephalopathy following cardiac arrest.

Neuroprognostication in patients suffering from post-anoxic brain injury following cardiac arrest has become increasingly challenging since the introduction of therapeutic temperature management (TTM). Advances in the interpretation of clinical exam findings, chemical biomarkers, electrophysiology, and neuroimaging have improved our ability to prognosticate; however, the continued prevalence of false positives among current prognostic assessments underlies the need for a more comprehensive approach.

Multimodal outcome characterization in comatose cardiac arrest (MOCHA) is an IRB-approved multi-center observational study. This study sample consists of 175 consecutive cardiac arrest patients treated at two urban hospitals from 2011-2017. Case selection was determined by availability of Glasgow Coma Scale (GCS) eye, motor, and total scores, Pittsburgh Cardiac Arrest Category (PCAC), and CT imaging results. Baseline characteristics were evaluated by t-test and chi-square. Poor outcome was defined as in-hospital mortality. Prognostic ability was evaluated by sensitivity and specificity testing.

No differences in survival to discharge were observed between sex, race, or ethnicity. Significant predictors of survival to discharge were day 2 GCS-motor > 5 (Specificity = 1.00 [95% CI 0.96, 1.00]) and initial PCAC < 2 (Specificity = 0.97 [0.92, 0.99]). Loss of gray-white matter differentiation on initial CT was specific for in-hospital mortality (0.86 [0.73, 0.94]), while sensitive markers included day 2 GCS-motor < 2 (0.98 [0.92, 1.00]), initial GCS < 8 (0.98 [0.93, 1.00], day 2 GCS < 8 (0.95 [0.90, 0.99]), and day 2 GCS-eye =1 (0.95 [0.88, 0.98]).