[Complete neurological recovery following prolonged cardiac arrest. Description of a clinical case].
We report a case of protracted intraoperative cardiac arrest (15 minutes), occurring in a patient with haemorrhagic shock in consequence of a bullet wound to the right hemithorax; external cardiac massage was immediately started and carried on until the restoration of spontaneous cardiac activity. In the immediate postoperative period, the patient presented seizure activity, treated with TPS in continuous infusion (2 mg/kg/h) and DPH (250 mg/die). Anticonvulsant therapy didn't allow a correct neurologic evaluation of the patient; that was possible only when treatment was suspended (4 days after ICU admission). Neurophysiological investigations (EEG and Somato-Sensorial Evoked Potentials) were undertaken; particularly SSEPs recorded no pathologic alteration of the cortical response. At the discharge from ICU the patient was completely awake after coma, a residual paresis of the right lower limb was present. We suggest that in post-anoxic coma, when anticonvulsant therapy is required, neurophysiological investigations improve the accuracy of early outcome prediction.
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Istituto di Anestesiologia e Rianimazione, Università degli Studi di Ferrara.
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D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001925:Brain Damage, Chronic / Q000175:diagnosis*; D002545:Brain Ischemia / Q000209:etiology; D003128:Coma / Q000209:etiology*; D004569:Electroencephalography; D004830:Epilepsy, Tonic-Clonic / Q000188:drug therapy / Q000209:etiology*; D005073:Evoked Potentials, Somatosensory; D006323:Heart Arrest / Q000150:complications; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology; D007431:Intraoperative Complications; D008168:Lung / Q000601:surgery; D055370:Lung Injury; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012771:Shock, Hemorrhagic / Q000150:complications; D013997:Time Factors; D014948:Wounds, Gunshot / Q000150:complications / Q000601:surgery
D000927:Anticonvulsants
Recupero neurologico completo dopo arresto cardiaco prolungato. Descrizione di un caso clinico.