Brain injury related to hypoxic-ischemic insults post-cardiac arrest is a highly morbid and often fatal condition for which neuroprognostication remains challenging. There has been a significant increase in studies assessing the accuracy of multimodal approaches in predicting poor neurological outcomes post-cardiac arrest, and contemporary guidelines recommend this approach. We conducted a systematic review to assess multimodal versus unimodal approaches in neuroprognostication for predicting a poor neurological outcome for adult post-cardiac arrest patients at hospital discharge or beyond.

PRISMA methodological standards were followed. MEDLINE, EMBASE and CINAHL were searched from inception until January 18, 2024, with no restrictions. Abstract and full-text review was completed in duplicate. Original studies assessing the prognostic accuracy (specificity and false positive rate [FPR]) of multimodal compared with unimodal approaches were included. The risk of bias was assessed using the QUIPS tool. Data were extracted in duplicate.

Of 791 abstracts, 12 studies were included. The FPR in predicting poor neurological outcomes ranged from 0% to 5% using a multimodal approach compared to 0% to 31% with a unimodal test. The risk of bias was moderate to high for most components.

A multimodal approach may improve the FPR in predicting poor neurological outcomes of post-cardiac arrest patients.