Prognostication after cardiac arrest and hypothermia: A prospective study
Article first published online: 27 JAN 2010
Copyright © 2010 American Neurological Association
Annals of Neurology
Volume 67, Issue 3, pages 301–307, March 2010
How to Cite
Rossetti, A. O., Oddo, M., Logroscino, G. and Kaplan, P. W. (2010), Prognostication after cardiac arrest and hypothermia: A prospective study. Ann Neurol., 67: 301–307. doi: 10.1002/ana.21984
- Issue published online: 29 MAR 2010
- Article first published online: 27 JAN 2010
- Accepted manuscript online: 27 JAN 2010 12:00AM EST
- Manuscript Accepted: 13 JAN 2010
- Manuscript Revised: 9 JAN 2010
- Manuscript Received: 17 NOV 2009
Current American Academy of Neurology (AAN) guidelines for outcome prediction in comatose survivors of cardiac arrest (CA) have been validated before the therapeutic hypothermia era (TH). We undertook this study to verify the prognostic value of clinical and electrophysiological variables in the TH setting.
A total of 111 consecutive comatose survivors of CA treated with TH were prospectively studied over a 3-year period. Neurological examination, electroencephalography (EEG), and somatosensory evoked potentials (SSEP) were performed immediately after TH, at normothermia and off sedation. Neurological recovery was assessed at 3 to 6 months, using Cerebral Performance Categories (CPC).
Three clinical variables, assessed within 72 hours after CA, showed higher false-positive mortality predictions as compared with the AAN guidelines: incomplete brainstem reflexes recovery (4% vs 0%), myoclonus (7% vs 0%), and absent motor response to pain (24% vs 0%). Furthermore, unreactive EEG background was incompatible with good long-term neurological recovery (CPC 1–2) and strongly associated with in-hospital mortality (adjusted odds ratio for death, 15.4; 95% confidence interval, 3.3–71.9). The presence of at least 2 independent predictors out of 4 (incomplete brainstem reflexes, myoclonus, unreactive EEG, and absent cortical SSEP) accurately predicted poor long-term neurological recovery (positive predictive value = 1.00); EEG reactivity significantly improved the prognostication.
Our data show that TH may modify outcome prediction after CA, implying that some clinical features should be interpreted with more caution in this setting as compared with the AAN guidelines. EEG background reactivity is useful in determining the prognosis after CA treated with TH. ANN NEUROL 2010;67:301–307