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Prognostication after cardiac arrest and hypothermia: A prospective study
Author(s) -
Rossetti Andrea O.,
Oddo Mauro,
Logroscino Giancarlo,
Kaplan Peter W.
Publication year - 2010
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.21984
Subject(s) - somatosensory evoked potential , electroencephalography , anesthesia , medicine , hypothermia , myoclonus , neurology , clinical neurophysiology , odds ratio , brainstem , confidence interval , prospective cohort study , cardiology , psychiatry
Objective 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. Methods 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). Results 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. Interpretation 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