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Postanoxic coma: how (long) should we treat?

Published online by Cambridge University Press:  01 February 2008

E. G. J. Zandbergen
E. G. J. Zandbergen*
Affiliation:
Ziekenhuis Rijnstate, Wagnerlaan, Arnhem, The Netherlands
*
Correspondence to: Eveline G. J. Zandbergen, Ziekenhuis Rijnstate, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands. E-mail: ezandbergen@alysis.nl; Tel: +31 26 3788876 (secretary)
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Summary

Postanoxic coma is a state of unconsciousness caused by global anoxia of the brain, most commonly due to cardiac arrest. Outcome after postanoxic coma lasting more than several hours is generally, but not invariably, poor. Recovery of consciousness reported in the literature varies from 8% to 72% of patients, but is mostly thought to be around 20–30% in patients surviving in coma for at least 24 h. Research is directed at defining factors that reliably predict poor outcome in these patients. Favourable outcome proves impossible to predict. Studies on outcome prediction have focussed mostly on neurological examination, clinical neurophysiological tests and biochemical parameters. The most recent and extensive study in this respect was the PROPAC study in The Netherlands (407 patients). This study confirmed earlier findings that bilaterally absent early cortical response after median nerve somatosensory potentials (absent somatosensory evoked potentials) is the most reliable predictor of poor outcome (no recovery of consciousness). A serum neuron-specific-enolase level >33 μg L−1 seemed equally reliable. In 2006, the American Practice Parameter on anoxic-ischaemic coma was published, summarizing the findings from the different studies. Poor outcome was defined as death, coma or severe disability after 6 months. The following factors were found to reliably predict this outcome: myoclonic status epilepticus within the first 24 h, absent pupillary responses after 24 h, absent corneal reflexes after 48 h, motor response to pain absent or extensor after 72 h and absent somatosensory evoked potentials (as defined above) after 1–3 days. Results for biochemical parameters (such as neuron-specific enolase) and neuroimaging are inconclusive.

Keywords

CARDIAC ARRESTOUTCOMECOMACEREBRAL HYPOXIA
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue S42 , February 2008 , pp. 39 - 42
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1. The Bible. 1 Kings 17: 17–22.Google Scholar
2.Kouwenhoven, WB, Jude, JR, Knickerbocker, GG. Closed chest cardiac massage. JAMA 1960; 173: 94–97.CrossRefGoogle ScholarPubMed
3.Pantridge, JF, Geddes, JS. A mobile intensive-care unit in the management of myocardial infarction. Lancet 1967; 2: 271–273.CrossRefGoogle ScholarPubMed
4.Levy, DE, Caronna, JJ, Singer, BH, Lapinski, RH, Frydman, H, Plum, F. Predicting outcome from hypoxic-ischemic coma. JAMA 1985; 253: 1420–1426.CrossRefGoogle ScholarPubMed
5.Edgren, E, Hedstrand, U, Kelsey, S, Sutton-Tyrrell, K, Safar, P. Assessment of neurological prognosis in comatose survivors of cardiac arrest. Lancet 1994; 343: 1055–1059.CrossRefGoogle ScholarPubMed
6.Hockaday, JM, Potts, F, Epstein, E, Bonazzi, A, Schwab, RS. Electroencephalographic changes in acute cerebral anoxia from cardiac or respiratory arrest. Electroenceph Clin Neurophysiol 1965; 18: 575–586.CrossRefGoogle ScholarPubMed
7.Thomassen, A, Wernberg, M. Prevalence and prognostic significance of coma after cardiac arrest outside intensive care and coronary care units. Acta Anaesth Scand 1979; 23: 143–148.CrossRefGoogle Scholar
8.JrLongstreth, WT, Diehr, P, Inui, TS. Prediction of awakening after out-of-hospital cardiac arrest. N Eng J Med 1983; 308: 1378–1382.CrossRefGoogle ScholarPubMed
9.Zandbergen, EGJ, Hijdra, A, Koelman, JHTM et al. . Prediction of poor outcome within the first three days of postanoxic coma. Neurology 2006; 66: 62–68.CrossRefGoogle Scholar
10.Lim, C, Alexander, MP, LaFleche, G, Schnyer, DM, Verfaellie, M. The neurological and cognitive sequelae of cardiac arrest. Neurology 2004; 63: 1774–1778.CrossRefGoogle ScholarPubMed
11.Zandbergen, EGJ, De Haan, RJ, Stoutenbeek, CP, Koelman, JHTM, Hijdra, A. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet 1998; 352: 1808–1812.CrossRefGoogle ScholarPubMed
12.Carter, BG, Butt, W. Review of the use of somatosensory evoked potentials in the prediction of outcome after severe brain injury. Crit Care Med 2001; 29: 178–186.CrossRefGoogle ScholarPubMed
13.Robinson, LR, Micklesen, PJ, Tirschwell, DL, Lew, HL. Predictive value of somatosensory evoked potentials for awakening from coma. Crit Care Med 2003; 31: 960–967.CrossRefGoogle ScholarPubMed
14.Booth, CM, Boone, RH, Tomlinson, G, Detsky, AS. Is this patient dead, vegetative, or severely neurologically impaired? JAMA 2004; 291: 870–879.CrossRefGoogle ScholarPubMed
15.Zandbergen, EGJ, De Haan, RJ, Hijdra, A. Systematic review of prediction of poor outcome in anoxic-ischaemic coma with biochemical markers of brain damage. Intensive Care Med 2001; 27: 1661–1667.CrossRefGoogle ScholarPubMed
16.Wijdicks, EFM, Hijdra, A, Young, GB, Bassetti, CL, Wiebe, S. 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. Neurology 2006; 67: 203–210.CrossRefGoogle Scholar
17.Bernard, SA, Gray, TW, Buist, MD et al. . Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002; 346: 557–563.CrossRefGoogle ScholarPubMed
18.The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346: 549–556.CrossRefGoogle Scholar
19.Tiainen, M, Kovala, TT, Takkunen, OS, Roine, RO. Somatosensory and brainstem evoked potentials in cardiac arrest patients treated with hypothermia. Crit Care Med 2005; 33: 1736–1740.CrossRefGoogle ScholarPubMed