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Prognosis after arrest

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Prognostication after cardiac arrest

Updated in June 2008

Circumstances surrounding CPR

  • Anoxia time, duration of cardiopulmonary resuscitation, asystole or pulseless electrical activity are related to poor outcome
  • However, none of them can accurately distinguish patients with poor and favourable outcome

Neurological features associated with poor outcome

The following features can accurately predict poor outcome

  • Myoclonus status epilepticus within first 24 hours in patients with primary circulatory arrest
  • Absent pupil reflexes within 1 to 3 days after cardiac arrest
  • Absent corneal reflexes within 1 to 3 days after cardiac arrest
  • Absent or extensor motor responses after 3 days

Electrophysiological studies

EEG

Generalized suppression ≤ 20µV, generalized epileptiform activity with burst-suppression pattern or generalized periodic complexes with flat background are strong indicators of poor outcome. However the prognostic accuracy are insufficient for outcome prediction

Somatosensory evoked potentials

  • Much less affected by drugs and metabolic disturbances
  • More accurate than EEG in prognostication
  • Bilateral absence of the N20 component of cortical SSEP with median nerve stimulation 1 to 3 after cardiac arrests accurately predicts  poor outcome

Biochemical markers

Serum neuron-specific enolase (NSE)

if > 33µg/L from 1 day to 3 days after cardiac arrests accurately predict poor outcome

Confounding factors in prognostication

Renal failure, liver failure, shock, metabolic disturbances, sedatives, neuromuscular blocking agents and induced hypothermia may affect the prognostic indicators

Reference

Practice Parameter: Prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review) NEUROLOGY 2006; 67: 203-210

 

 

İCharles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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