Systematic review of early prediction of poor outcome in anoxicischaemic coma

Cavernoma of cavernous sinus

“…On the other hand, the low false positive rates for SSEP and serum NSE confirm our previous findings 1,5 and are supported by subsequently reported data.…”

“…A positive predictive value of 100% has been demonstrated for the absence of early cortical responses (N20) of the somatosensory evoked potentials (SSEPs) in the first week after CPR, [1][2][3] and similar values were found for the absence of pupillary and corneal reflexes and of any motor response 3 days after the hypoxic-ischemic insult. 1,4 The usefulness of biochemical markers of brain damage in serum or CSF remained uncertain, because of the small number of patients in most studies and methodologic flaws in some. 5 With these reviews, a number of questions could not be answered.…”

“…The proportion of patients with poor outcome (87%) is at the upper end of the wide range reported for both retrospectively and prospectively studied cohorts, with mortality rates varying from 28 to 92%. 1 The main difference between these cohorts and the one we studied was the time of inclusion: We included only patients still unconscious 24 hours after CPR, whereas all other studies included patients with much shorter periods of unconsciousness, varying from the time of return of spontaneous circulation to a few hours thereafter. Because most patients who recover consciousness do so within the first day, inclusion of patients at a later stage explains the high proportion of patients with poor outcome in our cohort.…”

“…Treating physicians were blinded for the results of the first and second day SSEP and for all blood tests. Absence of SSEP at 72 hours was considered a sufficiently reliable predictor of poor outcome to allow its use for treatment decisions, [1][2][3] and the result of 72-hour SSEP testing was therefore made available to the treating physicians.…”

“…With regard to neurologic prognosis, they were offered the following guidelines: 1) Chances for survival or recovery of consciousness are virtually nil when the N20 of the SSEP or the pupillary reflexes or motor responses are absent or when the EEG is isoelectric at 72 hours or later; 2) chances for survival without severe disability are virtually nil with a burst-suppression EEG at 72 hours or later or with motor response flexion or worse at 7 days or later. 1,12 Timing and motivation of any change in treatment level were documented. Treatment levels were no treatment restrictions; treatment restricted to standard supportive care, such as can be given on regular wards (no-resuscitation order, weaning from the ventilator and transfer to the regular ward, no readmission to the intensive care unit; all other treatment given when necessary); and no treatment other than palliation.…”