Care pathways for individuals with post-anoxic disorder of consciousness (CaPIADoC): an inter-society Consensus Conference

期刊论文
发表日期：

2024年11月26日

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Anna Estraneo,
Alfonso Magliacano,
Francesco De Bellis,
Aldo Amantini,
Susanna Lavezzi,
Antonello Grippo,
Marta Aloisi,
Rita Formisano,
Nicoletta Anzalone,
Sergio Bagnato,
Carlo Alberto Castioni,
Carlo Cavaliere,
Riccardo Carrai,
Cesarina Cossu,
Maria Grazia Celani,
Antonio De Tanti,
Paolo Fogar,
Nicola Latronico,
Matilde Leonardi,
Francesco Lombardi,
Silvia Marino,
Anna Teresa Mazzeo,
Oriano Mecarelli,
Stefano Meletti,
Chiara Minardi,
Andrea Montis,
Francesco Piccione,
Chiara Robba,
Gian Pietro Salvi,
Federico Scarponi,
Alessandra Splendiani,
Laura Tadini,
Maurizio Vergari,
Elena Tartara,
Mauro Zampolini

摘要

Background

Accurate recognition of consciousness level and detection of neurological complications since the intensive care unit are crucial for an appropriate prognostication and tailored treatment in patients with post-anoxic disorder of consciousness (DoC).

Objective

The present inter-society Consensus Conference aimed at addressing current debates on diagnostic and prognostic procedures.

Methods

Twelve working groups involving 22 multidisciplinary professionals (membership of 9 Scientific Societies and 2 patients’ family Associations) conducted a systematic literature review focused on 12 questions addressing diagnosis (n = 5) and prognosis (n = 7). The quality of evidence of the included studies was evaluated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. A Jury involving Scientific Societies and patients’ family Associations provided recommendations based on the evidence levels and expert opinion.

Results

An overall number of 1,219 papers was screened, and 21 were included in the review. Working groups produced a report on strengths and limits of evidence for each question. The overall suggestion was to use a multimodal assessment combining validated clinical scales, neurophysiological exams, and neuroimaging in diagnostic and prognostic procedure, to guide personalized treatment. A strong recommendation was to use standardized terminologies and diagnostic criteria for ensuring homogeneity and appropriateness in patients management.

Conclusion

This multidisciplinary Consensus Conference provided the first operational recommendations for a good clinical practice procedure for patients with post-anoxic DoC. A periodic review will be necessary based on future evidence from the literature and implementation of the present recommendations.