Early multimodal predictors of good neurological outcome in comatose patients after cardiac arrest: a prospective single-center cohort study.

BACKGROUND AND

OBJECTIVES

Post-cardiac arrest (CA) prognostication primarily focuses on predicting poor outcome, whereas early markers of good prognosis remain less explored. We aimed to identify early predictors of favorable outcome at 3 months in comatose CA survivors.

METHODS

We prospectively enrolled adult patients with post-anoxic coma admitted to the Intensive Care Unit of a secondary-care hospital (2020-2025). Demographic, CA-related, clinical, electroencephalographic (EEG), neuron-specific enolase (NSE) and neuroimaging data were collected. Good outcome was defined as Cerebral Performance Category (CPC) 1-2 at 3 months. Logistic regression analyses identified independent predictors of good outcome. Model performance was internally validated with bootstrap resampling.

RESULTS

Among 121 included patients (median age = 66; 72% male), outcome was available for 118, of whom 42.3% achieved good outcome. Patients with CPC 1-2 were younger, had predominant shockable initial rhythms and cardiac etiology of CA, higher Glasgow Coma Scale scores, lower NSE levels, and decreasing NSE trend. Peak NSE ≤ 36 ng/mL was the optimal cut-off for favorable prognosis. Early benign EEG (continuous/nearly continuous background with preserved reactivity ≤72 h) was associated with neurological recovery. In multivariable analysis, independent predictors of favorable outcome were younger age (OR 0.92, 95% CI 0.86-0.99), shockable initial rhythm (OR 28.0, 95% CI 3.87-202.1), early benign EEG (OR 10.76, 95% CI 1.95-59.4) and peak NSE ≤ 36 ng/mL (OR 43.17, 95% CI 6.01-309.9). The model showed excellent discrimination (apparent AUC 0.97, optimism-corrected AUC 0.96).

CONCLUSIONS

In comatose post-CA patients, a model combining age, initial rhythm, early benign EEG and peak NSE independently predicted good outcome at 3 months.