The Prognostication of Cerebral Hypoxia after Out-of-Hospital Cardiac Arrest in Adults

Abstract

Early determination of outcome after out-of-hospital cardiopulmonary resuscitation is a common problem with great ethical, economic, social and legal consequences. Although there has been a fulminant development of emergency medicine during the last three decades, severe cerebral damage sometimes cannot be avoided. For neurological outcome prediction after cardiac arrest clinical neurological signs, electrophysiological examinations, neuroimaging tests, and laboratory parameters in serum and cerebrospinal fluid are used today, nevertheless, there still remains a considerable degree of uncertainty. However, although prognostic criteria which enable the clinician to stop treatment cannot be given at the present time, useful applications of early prognostication after cardiac arrest range from counseling of families, triage decisions, and do-not-resuscitate decisions to future clinical investigations of brain resuscitative measures.

Post–Cardiac Arrest Syndrome

“…266,268 Intra-Cardiac Arrest Factors Many factors during the resuscitation process have been associated with functional outcome, but no single factor has been identified as a reliable predictor. Some association with poor functional outcome has been found between a long interval between collapse and the start of CPR and increased duration of CPR to ROSC, 260,269 but high false-positive rates (FPRs) make this unreliable for predicting poor outcome. 254 Furthermore, the quality of CPR is likely to influence outcome.…”

Novel Early EEG Measures Predicting Brain Recovery after Cardiac Arrest

“…Most of the patients that are successfully resuscitated undergo prolonged coma and only 10∼20% survive to hospital discharge. Among the survivors, neurological complications and cognitive deficits are the major cause of morbidity and continued disability [1][2][3][4][5][6][7].…”

Prognosis following Postanoxic Myoclonus Status epilepticus

“…The majority of survivors remain comatose and outcome is variable; some may remain in a vegetative state, while others may eventually recover completely [1]. Absent motor response to pain for more than 2 days, absence of corneal and papillary reflexes for more than 24 h, and persistence of a Glasgow Coma Scale score <5 for more than 2–3 days strongly predict death or poor outcome [2,3,4,5,6,7,8,9,10]. In addition to these clinical signs, a number of neurophysiological and laboratory tests, such as absence of cortical somatosensory evoked potential, CSF creatinine kinase and lactate have been identified as prognostic indicators[10,11,12].…”