Prognosis of coma after therapeutic hypothermia: A prospective cohort study
| Autor: | Janneke Horn, Hazra S. Biemond, Durk F. Zandstra, Frank H. Bosch, Michael A. Kuiper, Aline Bouwes, Henry C. Weinstein, Jan M. Binnekade, Marcel M. Verbeek, Arnoud C. Toornvliet, Bas M. Kors, A. Hijdra, Johannes H. T. M. Koelman |
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| Přispěvatelé: | Other Research, Intensive Care Medicine, AII - Amsterdam institute for Infection and Immunity, ANS - Amsterdam Neuroscience, Neurology, Other departments, NCA - Neurodegeneration, Amsterdam Neuroscience - Neurodegeneration |
| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_treatment DCN MP - Plasticity and memory Glasgow Outcome Scale law.invention Hypothermia Induced law Evoked Potentials Somatosensory Humans Medicine Glasgow Coma Scale Prospective Studies Cardiopulmonary resuscitation Coma Prospective cohort study DCN NN - Brain networks and neuronal communication Aged Neurologic Examination business.industry Middle Aged Hypothermia Prognosis Intensive care unit Cardiopulmonary Resuscitation Confidence interval Median Nerve Neurology Phosphopyruvate Hydratase Anesthesia Female Neurology (clinical) medicine.symptom business |
| Zdroj: | Annals of Neurology, 71, 2, pp. 206-12 Annals of neurology, 71(2), 206-212. John Wiley and Sons Inc. Bouwes, A, Binnekade, J M, Kuiper, M A, Bosch, F H, Zandstra, D F, Toornvliet, A C, Biemond, H S, Kors, B M, Koelman, J H T M, Verbeek, M M, Weinstein, H C, Hijdra, A & van Horn, J 2012, ' Prognosis of coma after therapeutic hypothermia: A prospective cohort study ', Annals of Neurology, vol. 71, no. 2, pp. 206-212 . https://doi.org/10.1002/ana.22632 Annals of Neurology, 71(2), 206-212. John Wiley and Sons Inc. Annals of Neurology, 71, 206-12 |
| ISSN: | 0364-5134 |
| Popis: | Item does not contain fulltext OBJECTIVE: This study was designed to establish the reliability of neurologic examination, neuron-specific enolase (NSE), and median nerve somatosensory-evoked potentials (SEPs) to predict poor outcome in patients treated with mild hypothermia after cardiopulmonary resuscitation (CPR). METHODS: This multicenter prospective cohort study included adult comatose patients admitted to the intensive care unit (ICU) after CPR and treated with hypothermia (32-34 degrees C). False-positive rates (FPRs 1 - specificity) with their 95% confidence intervals (CIs) were calculated for pupillary light responses, corneal reflexes, and motor scores 72 hours after CPR; NSE levels at admission, 12 hours after reaching target temperature, and 36 hours and 48 hours after collapse; and SEPs during hypothermia and after rewarming. The primary outcome was poor outcome, defined as death, vegetative state, or severe disability (Glasgow Outcome Scale 1-3) after 6 months. RESULTS: Of 391 patients included, 53% had a poor outcome. Absent pupillary light responses (FPR 1; 95% CI, 0-7) or absent corneal reflexes (FPR 4; 95% CI, 1-13) 72 hours after CPR, and absent SEPs during hypothermia (FPR 3; 95% CI, 1-7) and after rewarming (FPR 0; 95% CI, 0-18) were reliable predictors. Motor scores 72 hours after CPR (FPR 10; 95% CI, 6-16) and NSE levels were not. INTERPRETATION: In patients with persisting coma after CPR and therapeutic hypothermia, use of motor score or NSE, as recommended in current guidelines, could possibly lead to inappropriate withdrawal of treatment. Poor outcomes can reliably be predicted by testing brainstem reflexes 72 hours after CPR and performing SEP. 01 februari 2012 |
| Databáze: | OpenAIRE |
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