Practice Parameter: Prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology Export

@article{citeulike:2797116, abstract = {Objective: To systematically review outcomes in comatose survivors after cardiac arrest and cardiopulmonary resuscitation (CPR). Methods: The authors analyzed studies (1966 to 2006) that explored predictors of death or unconsciousness after 1 month or unconsciousness or severe disability after 6 months. Results: The authors identified four class I studies, three class II studies, and five class III studies on clinical findings and circumstances. The indicators of poor outcome after CPR are absent pupillary light response or corneal reflexes, and extensor or no motor response to pain after 3 days of observation (level A), and myoclonus status epilepticus (level B). Prognosis cannot be based on circumstances of CPR (level B) or elevated body temperature (level C). The authors identified one class I, one class II, and nine class III studies on electrophysiology. Bilateral absent cortical responses on somatosensory evoked potential studies recorded 3 days after CPR predicted poor outcome (level B). Burst suppression or generalized epileptiform discharges on EEG predicted poor outcomes but with insufficient prognostic accuracy (level C). The authors identified one class I, 11 class III, and three class IV studies on biochemical markers. Serum neuron-specific enolase higher than 33 {micro}g/L predicted poor outcome (level B). Ten class IV studies on brain monitoring and neuroimaging did not provide data to support or refute usefulness in prognostication (level U). Conclusion: Pupillary light response, corneal reflexes, motor responses to pain, myoclonus status epilepticus, serum neuron-specific enolase, and somatosensory evoked potential studies can reliably assist in accurately predicting poor outcome in comatose patients after cardiopulmonary resuscitation for cardiac arrest. 10.1212/01.wnl.0000227183.21314.cd}, author = {Wijdicks, E. F. M. and Hijdra, A. and Young, G. B. and Bassetti, C. L. and Wiebe, S.}, citeulike-article-id = {2797116}, citeulike-linkout-0 = {http://dx.doi.org/10.1212/01.wnl.0000227183.21314.cd}, citeulike-linkout-1 = {http://neurology.org/cgi/content/abstract/67/2/203}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/16864809}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=16864809}, day = {25}, doi = {10.1212/01.wnl.0000227183.21314.cd}, journal = {Neurology}, keywords = {anoxique, coma, post}, month = {July}, number = {2}, pages = {203--210}, posted-at = {2009-02-14 13:03:10}, priority = {2}, title = {Practice Parameter: Prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology}, url = {http://dx.doi.org/10.1212/01.wnl.0000227183.21314.cd}, volume = {67}, year = {2006} }

TY - JOUR ID - citeulike:2797116 L3 - citeulike-article-id:2797116 N2 - Objective: To systematically review outcomes in comatose survivors after cardiac arrest and cardiopulmonary resuscitation (CPR). Methods: The authors analyzed studies (1966 to 2006) that explored predictors of death or unconsciousness after 1 month or unconsciousness or severe disability after 6 months. Results: The authors identified four class I studies, three class II studies, and five class III studies on clinical findings and circumstances. The indicators of poor outcome after CPR are absent pupillary light response or corneal reflexes, and extensor or no motor response to pain after 3 days of observation (level A), and myoclonus status epilepticus (level B). Prognosis cannot be based on circumstances of CPR (level B) or elevated body temperature (level C). The authors identified one class I, one class II, and nine class III studies on electrophysiology. Bilateral absent cortical responses on somatosensory evoked potential studies recorded 3 days after CPR predicted poor outcome (level B). Burst suppression or generalized epileptiform discharges on EEG predicted poor outcomes but with insufficient prognostic accuracy (level C). The authors identified one class I, 11 class III, and three class IV studies on biochemical markers. Serum neuron-specific enolase higher than 33 {micro}g/L predicted poor outcome (level B). Ten class IV studies on brain monitoring and neuroimaging did not provide data to support or refute usefulness in prognostication (level U). Conclusion: Pupillary light response, corneal reflexes, motor responses to pain, myoclonus status epilepticus, serum neuron-specific enolase, and somatosensory evoked potential studies can reliably assist in accurately predicting poor outcome in comatose patients after cardiopulmonary resuscitation for cardiac arrest. 10.1212/01.wnl.0000227183.21314.cd IS - 2 JF - Neurology EP - 210 TI - Practice Parameter: Prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology VL - 67 SP - 203 KW - anoxique KW - coma KW - post AU - Wijdicks, EFM AU - Hijdra, A AU - Young, GB AU - Bassetti, CL AU - Wiebe, S PY - 2006/07/25/ UR - http://dx.doi.org/10.1212/01.wnl.0000227183.21314.cd ER -