x = ( A) + (3.296 B) (0.070 C) (1.006 D) + (2.426 E) Receiver Operating Characteristic ROC

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3 Glasgow outcome scale GOS GOS 4 n= A C D 5 ph B E = 1/(1 + e x) x = ( 0.0 A) + (.96 B) (0.070 C) (1.006 D) + (.46 E) estimated probability n=01 5 Receiver Operating Characteristic ROC 80% 9% 90%. 1- extracorporeal cardiopulmonary resuscitation 4 ECPR 1

4 interleukin IL -6 IL-85 6 NSE6 7 glial fibrillary acidic protein GFAP S100b BB10 computed tomography CT magnetic resonance imaging MRI

5 CPR cardiopulmonary resuscitation ph 6 16 GOS 4 GOS 1- CPR 1 dead vegetative state severe disability 4 moderate disability 5 good recovery 5

6 U P 17 Sidak P < 0.01 =0 =1 =1 =0 CPR =0 =0 = 1; =1 =1 =0 =0 =1 =0 area under the curve AUC ROC 6 4 =1

7 n = 488) n = 6) ( n = 5) (n = 477) (n = 55) (n = 4) n = 1) n = 7) ( n = 5) (n = 01) (n = 5) (n = 176) 1 5

8 CPR a P-valueb (n = 477) (n = 01) 64 ± 0 7 ± 16 < (67) 104 (5) < (46) 9 (46) (59) 1 (66) (7) 76 (8) < (18) 6 (18) ± 15 1 ± 15 < 0.01 ± 19 0 ± (1) 9 (14) (8) 6 () (8) 1 (6) ± ± ± ± (1) 5 (1) 0.74 CPR mm ph a a b CPR cardiopulmonary resuscitation 6 P < 0.01

9 good recovery 5 moderate disability vegetative state 79 4 severe disability dead 40 A C E ph B D 5 X A~E = 1/(1 + e x) x = ( 0.0 A) + (.96 B) (0.070 C) (1.006 D) + (.46 E) A C D B E ph P mm a ph 0.1 a 7

10 AUC ROC % 94% 9% ROC 8 4

11 % 90% ROC 0.18 AUC 80% 0.94 AUC ROC 9

12 Hayakawa 18 80% 9% 11 5 ph Hayakawa 18 1 Fisher CPR 19-4 Wijdicks % 1 HACA study 15% 10

13 Limitation limitation % 11 1

14 1

15 1. Peberdy MA Callaway CW Neumar RW et al. Part 9: post-cardiac arrest care: 010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 010; 1: S Bernard SA Gray TW Buist MD et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N. Engl. J. Med. 00; 46: Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N. Engl. J. Med. 00; 46: Cave DM Gazmuri RJ Otto CW et al. Part 7: CPR techniques and devices: 010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 010; 1: S Oda Y Tsuruta R Kasaoka S Inoue T Maekawa T. The cutoff values of intrathecal interleukin 8 and 6 for predicting the neurological outcome in cardiac arrest victims. Resuscitation 009; 80: Ekmektzoglou KA Xanthos T Papadimitriou L. Biochemical markers (NSE S-100 IL-8) as predictors of neurological outcome in patients after cardiac arrest and return of spontaneous circulation. Resuscitation 007; 75: Almaraz AC Bobrow BJ Wingerchuk DM Wellik KE Demaerschalk BM. Serum neuron specific enolase to predict neurological outcome after cardiopulmonary resuscitation: a critically appraised topic. Neurologist 009; 15: Oda Y Tsuruta R Fujita M et al. Prediction of the neurological outcome with intrathecal high mobility group box 1 and S100B in cardiac arrest victims. Resuscitation 01; 8: Kaneko T Kasaoka S Miyauchi T et al. Serum glial fibrillary acidic protein as a predictive biomarker of neurological outcome after cardiac arrest. Resuscitation 009; 80: Tirschwell DL Longstreth WT Jr Rauch-Matthews ME et al. Cerebrospinal fluid creatine kinase BB isoenzyme activity and neurologic prognosis after cardiac arrest. Neurology 1997; 48: Wijdicks EF Hijdra A Young GB Bassetti CL Wiebe S; Quality Standards 1

16 Subcommittee of the American Academy of Neurology. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 006; 67: Madl C Grimm G Kramer L et al. Early prediction of individual outcome after cardiopulmonary resuscitation. Lancet 199; 41: Nakabayashi M Kurokawa A Yamamoto Y. Immediate prediction of recovery of consciousness after cardiac arrest. Intensive Care Med. 001; 7: Torbey MT Selim M Knorr J Bigelow C Recht L. Quantitative analysis of the loss of distinction between gray and white matter in comatose patients after cardiac arrest. Stroke 000; 1: Choi SP Park HK Park KN et al. The density ratio of grey to white matter on computed tomography as an early predictor of vegetative state or death after cardiac arrest. Emerg. Med. J. 008; 5: Jennett B Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1: Westfall PH Young SS. Resampling-based multiple testing. New York: Wiley-Interscience Hayakawa K Tasaki O Hamasaki T et al. Prognostic indicators and outcome prediction model for patients with return of spontaneous circulation from cardiopulmonary arrest: the Utstein Osaka Project. Resuscitation 011; 8: Fischer M Fischer NJ Schüttler J. One-year survival after out-of-hospital cardiac arrest in Bonn City: outcome report according to the 'Utstein Style'. Resuscitation 1997; : Booth CM Boone RH Tomlinson G Detsky AS. Is this patient dead vegetative or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA 004; 91: Swor RA Jackson RE Cynar M et al. Bystander CPR ventricular fibrillation and survival in witnessed unmonitored out-of-hospital cardiac arrest. Ann. Emerg. Med. 1995; 5: Schultz SC Cullinane DC Pasquale MD Magnant C Evans SR. Predicting in-hospital 14

17 mortality during cardiopulmonary resuscitation. Resuscitation 1996; : Parish DC Dane FC Montgomery M Wynn LJ Durham MD. Resuscitation in the hospital: differential relationships between age and survival across rhythms. Crit Care Med 1999; 7: Bar-Joseph G Kette F von Planta M Wiklund L. Acid-base considerations and buffer therapy. In: Paradis NA Halperin HR Kern KB Wenzel V Chamberlain DA editors. Cardiac arrest: The Science and Practice of Resuscitation Medicine nd ed. Cambridge Cambridge University Press 007; Shinozaki K Oda S Sadahiro T et al. Blood ammonia and lactate levels on hospital arrival as a predictive biomarker in patients with out-of-hospital cardiac arrest. Resuscitation 011; 8:

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