The prognostic significance of coma-rating, duration of anoxia and cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Abstract

Early determination of outcome after successful prehospital cardiopulmonary resuscitation (CPR) is a common problem with great ethical, economic, social, and legal consequences. We prospectively investigated 112 adult patients who had been resuscitated after out-of-hospital cardiac arrest (CA). The aim of our study was to determine whether coma rating by the mobile intensive care unit (MICU) is a useful tool for outcome prediction. For neurological assessment the Innsbruck Coma Scale (ICS) was used initially and after return of spontaneous circulation (ROSC) or 20-30 min after the start of CPR, before any sedating drugs were given. The duration of anoxia and CPR were determined with the automatically recorded emergency call protocol of the dispatch centre and the protocol of the MICU. For estimation of cerebral outcome at the time of discharge from hospital we used the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). Restoration of spontaneous circulation was achieved in 42 patients (37%), and 15 (13%) were discharged from hospital. The first coma rating performed immediately at the time of arrival on scene had no significant prognostic value for prediction of neurological outcome (P = 0.204) and survival (P = 0.103). The second coma rating (performed after ROSC or 20-30 min after the start of CPR), however, demonstrated a significant correlation with neurological outcome (P = 0.0000) and survival (P = 0.0000), a correlation which was comparable to both duration of anoxia and duration of CPR. In patients with out-of-hospital cardiac arrest prognostic information could be obtained with the ICS as early as 20-30 min after the start of cardiopulmonary resuscitation.

Clinical examination for prognostication in comatose cardiac arrest patients

“…1,4 Patients who recover consciousness early after arrest commonly experience good outcomes. 12 Inclusion of noncomatose patients would have diluted our results. We were stricter than Levy et al, excluding patients with eye opening, moaning (thus responding to pain or need), or with motor responses of withdrawal or better.…”

Is This Patient Dead, Vegetative, or Severely Neurologically Impaired?

“…31,32 Fourteen accuracy articles describing 11 different studies met our inclusion criteria (TABLE 3). [33][34][35][36][37][38][39][40][41][42][43][44][45][46] We had 100% agreement on the inclusion of studies for the systematic review. Reasons for excluding relevant studies included studies that did not present neurological outcomes as CPC 1 and 2 as good and CPC coma, 55,56 and studies that presented the same data set.…”

“…37,42 In 1997, Berek et al 33 examined the utility of Innsbruck Coma Scale in 42 comatose patients who survived prehospital arrest. 33 The Innsbruck Coma Scale (ICS) includes an assessment of the GCS components in addition to various brainstem reflexes. A score from 0 to 23 is assigned.…”

The role of cranial computed tomography in the immediate post-cardiac arrest period

“…Attempted resuscitations occur in approximately 60% of these cases, while 22-37% have a return of spontaneous circulation (ROSC) and live long enough to be transported to a hospital [2][3][4]. Patients who initially survive cardiac arrest are often admitted to an intensive care unit comatose and on mechanical ventilation; whether or not a screening cranial CT scan is necessary in the immediate post-arrest period remains unclear.…”