Guidelines Predict Outcome in Post-CPR Comatose Patients
American Academy of Neurology committee finds reliable indicators of poor outcome
MONDAY, July 24 (HealthDay News) -- The Quality Standards Subcommittee of the American Academy of Neurology has developed a decision algorithm that can reliably predict poor outcome in comatose patients following cardiopulmonary resuscitation. The algorithm is published in the July 25 issue of Neurology.
Eelco Wijdicks, M.D., of the Mayo Clinic College of Medicine in Rochester, Minn., and colleagues searched medical databases for studies conducted between 1966 and 2006 that provided outcomes for comatose survivors after cardiopulmonary resuscitation. Poor outcome was defined as death, unconscious after one month, or unconscious or severe disability after six months.
Among the indicators of poor prognosis were absent papillary light responses or corneal reflex after three days, extensor or no motor responses within the same time, myoclonus status epilepticus, bilateral absent cortical responses on somatosensory evoked potential studies also within three days, or high levels of serum neuron-specific enolase (greater than 33 μg/L).
The treatment decision-making process will rely on the timely availability of laboratory tests and should involve communication with family members or proxy. "When a poor outcome is anticipated, the need for life supportive care (mechanical ventilation, use of vasopressors or inotropic agents to hemodynamically stabilize the patient) must be discussed," they write.