Early prediction of individual outcome after cardiopulmonary resuscitation

Madl, Christian; Grimm, G; Kramer, Ludwig; Yeganehfar, Wafa; Sterz, Fritz; Schneider, Barbara; Kranz, Alexander; Schneeweiß, Bruno; Lenz, Kurt

doi:10.1016/0140-6736(93)93061-5

Cited by 167 publications

(74 citation statements)

References 21 publications

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“…Short-latency SEPs lack the capacity to identify patients whose outcomes will be favorable after cardiac arrest. Long-latency SEPs have been found useful even for this purpose by Austrian investigators (22). Madl et al have previously shown that in normothermic cardiac arrest patients, a latency Ͼ130 msec to cortical evoked potential N70 peak or absent N70 peaks predict poor outcome with a specificity of 97% and sensitivity of 94%.…”

Section: Discussionmentioning

confidence: 99%

Somatosensory and brainstem auditory evoked potentials in cardiac arrest patients treated with hypothermia*

Tiainen

Kovala

Takkunen

et al. 2005

Critical Care Medicine

173

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Section: Discussionmentioning

confidence: 99%

Somatosensory and brainstem auditory evoked potentials in cardiac arrest patients treated with hypothermia*

Tiainen

Kovala

Takkunen

et al. 2005

Critical Care Medicine

173

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“…Within the past few years, various attempts have been made to assess brain damage in comatose patients soon after cardiac arrest. [3][4][5][6][7][8][9][10] Most of them, however, exhibit major limitations. A recent meta-analysis of the clinical and electrophysiological predictors of poor outcome in anoxic-ischemic coma based on data from Ͼ4500 patients suggested that the absence of N20 components of somatosensory evoked potentials in comatose patients with anoxic brain injury and the absence of pain or pupillary responses at 72 hours after cardiac arrest confirm that continuation of life support is futile.…”

Section: Discussionmentioning

confidence: 99%

“…Various attempts, including neurological evaluation, cranial CT, electroencephalogram, somatosensory evoked potentials, and measurement of cerebral oxygen consumption, have been made to assess brain damage in comatose patients soon after cardiac arrest. [3][4][5][6][7][8][9][10] Early neurological and electrophysiological evaluations, however, do not predict cerebral outcome. 11 A serum marker that reflects the severity of brain damage as accurately as biochemical markers do in myocardial injury, 12 however, would improve early evaluation and quantification of post-cardiac arrest brain damage.…”

mentioning

confidence: 99%

Astroglial Protein S-100 Is an Early and Sensitive Marker of Hypoxic Brain Damage and Outcome After Cardiac Arrest in Humans

et al. 2001

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Background-The results of early conventional tests do not correlate with cerebral outcome after cardiac arrest. We investigated the serum levels of astroglial protein S-100 as an early marker of brain damage and outcome after cardiac arrest. Methods and Results-In 66 patients undergoing cardiopulmonary resuscitation after nontraumatic cardiac arrest, blood samples for the evaluation of S-100 were drawn immediately after and 15, 30, 45, and 60 minutes; 2, 8, 24, 48, and 72 hours; and 7 days after initiation of cardiopulmonary resuscitation. Moreover, the serum levels of neuron-specific enolase were determined between 2 hours and 7 days. If patients survived for Ͼ48 hours, brain damage was assessed by a combination of neurological, cranial CT, and electrophysiological examinations. Overall, 343 blood samples were taken for the determination of S-100. Maximum S-100 levels within 2 hours after cardiac arrest were significantly higher in patients with documented brain damage (survivors and nonsurvivors, 3.70Ϯ0.77 g/L) than in patients without brain damage (0.90Ϯ0.29 g/L). Significant differences between these 2 groups were observed from 30 minutes until 7 days after cardiac arrest. In addition, the positive predictive value of the S-100 test at 24 hours for fatal outcome within 14 days was 87%, and the negative predictive value was 100% (PϽ0.001). With regard to neuron-specific enolase, significant differences between patients with documented brain damage and those with no brain damage were found at 24, 48, and 72 hours and 7 days. Conclusions-Astroglial protein S-100 is an early and sensitive marker of hypoxic brain damage and short-term outcome after cardiac arrest in humans.

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“…Although some authors have successfully shown that the early SSEPs are highly predictive for outcome after cerebral trauma, 36 it appears from this analysis, that the outcome following head injury cannot be accurately predicted from the initial SSEP responses. This is substantiated by others who have found that if the cortical responses are near normal in the first 24 hours after trauma, then SSEPs should be repeated later in the monitoring period before an accurate prediction can be given.…”

Section: Sseps and Outcomementioning

confidence: 90%

Somatosensory Evoked Potentials and Intracranial Pressure in Severe Head Injury

Konasiewicz

Moulton

Shedden

1994

Can. j. neurol. sci.

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The purpose of this study was to explore the relationship between neurologic function, using a quantitative measurement of continuous somatosensory evoked potentials (SSEPs), and intracranial pressure (ICP) following traumatic brain injury. During a 6 year period, severely headinjured patients with a Glascow Coma Scale < 8 who were not moribund were monitored with SSEPs and ICP measurements. SSEPs from each hemisphere and ICP were recorded hourly for each patient. Neurologic outcomes were scored using the Glasgow Outcome Scale at three months post injury. Although initial SSEP amplitude did not correlate well with outcome, final SSEP summed peak to peak amplitude from both hemispheres (p = .0001), the best hemisphere (p = .0004), and the worst hemisphere (p = .0001) correlated well with the Glasgow Outcome Scale groups. Of a total of 72 patients, 40 had deteriorating SSEPs and 32 had stable or improving SSEPs. Peak ICP values were not statistically different in these groups (p = .6). Among patients with deteriorating SSEPs, 52.5% lost the greatest proportion of hemispheric electrical activity prior to ICP elevation. In the remaining patients, the percent reduction of SSEP activity after peak ICP levels was not statistically different from the percent reduction in SSEP activity prior to the peak ICP levels (p = .9). This data suggests that in a select group of patients with severe head injury, ICP does not cause SSEP deterioration, but rather is the consequence of deterioration of brain function.Resume: Potentiels evoques somesthesiques et pression intracranienne dans les traumatismes craniens severes. Le but de cette etude etait d'explorer, au moyen d'une mesure quantitative des potentiels eVoqufis somesthesiques (PESs) continus, la relation entre la fonction neurologique et la pression intracranienne suite a un traumatisme cranien.

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Early prediction of individual outcome after cardiopulmonary resuscitation

Cited by 167 publications

References 21 publications

Somatosensory and brainstem auditory evoked potentials in cardiac arrest patients treated with hypothermia*

Somatosensory and brainstem auditory evoked potentials in cardiac arrest patients treated with hypothermia*

Astroglial Protein S-100 Is an Early and Sensitive Marker of Hypoxic Brain Damage and Outcome After Cardiac Arrest in Humans

Somatosensory Evoked Potentials and Intracranial Pressure in Severe Head Injury

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