Predicting outcome in hypoxic-ischemic coma. A prospective clinical and electrophysiologic study.
A prospective analysis of 40 patients with hypoxic-ischemic coma lasting at least 6 h following sudden cardiac arrest was undertaken. The patients, all of whom had preserved brain-stem function, were studied electrophysiologically with electroencephalography (EEG), and median nerve somatosensory evoked potentials (SEPs) within 48 h to establish prognostic indices. Our results indicate that preserved brain-stem function does not necessarily predict favorable outcome following cardiac arrest as 26 of 40 (65%) patients died without awakening. The bilateral absence of cortical evoked potentials predicted death without awakening in 19 of 26 patients (73%) while malignant EEG change was similarly predictive in 11 patients (42%). Bilateral absence of cortical evoked potentials and/or malignant EEG change reliably predicted unfavorable outcome in 21/26 patients (81%). Patients with normal or delayed central conduction time (CCT) as well as 'benign' or 'uncertain' EEG findings had an uncertain prognosis as some entered a persistent vegetative state (PVS) or died without awakening. Fourteen patients (35%) awakened of whom 5 (13%) recovered completely while another 9 (23%) had varying degrees of motor or cognitive impairment. SEP and EEG findings did not distinguish between these outcomes.
Rothstein
T L
TL
Dept. of Medicine (Neurology), University of Washington, Seattle, WA.
Thomas
E M
EM
Sumi
S M
SM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002545:Brain Ischemia / Q000150:complications*; D003128:Coma / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D003402:Creatine Kinase / Q000134:cerebrospinal fluid; D004569:Electroencephalography; D004594:Electrophysiology; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006323:Heart Arrest / Q000150:complications; D006801:Humans; D000860:Hypoxia / Q000150:complications*; D007527:Isoenzymes; D008297:Male; D008475:Median Nerve / Q000503:physiopathology; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies
D007527:Isoenzymes; D003402:Creatine Kinase