Early prediction of individual outcome after cardiopulmonary resuscitation.
Prediction of individual outcome after cardiopulmonary resuscitation is of major medical, ethical, and socioeconomic interest but uncertain. We studied the early predictive potency of evoked potential recording after cardiac arrest in 66 resuscitated patients who returned to spontaneous circulation but were unconscious and mechanically ventilated. Detailed long-latency and short-latency sensory evoked potentials were recorded and neurological evaluations were done 4-48 h after admission to intensive care. In all 17 patients with favourable outcome (cerebral performance categories 1 and 2) the cortical evoked potential N70 peak, a reliable measure of cortical function, was detected between 74 and 116 ms. In 49 patients with bad outcome (categories 4 and 5) the N70 peak was absent in 35 or found with a delay between 121 and 171 ms in 14 (p < 0.05 vs favourable outcome). Thus the predictive ability was 100% with cutoff of 118 ms. To confirm reproducibility and validity, repeated tracings, and linked-earlobe referenced techniques were done and gave similar results. Early recording of long-latency evoked potentials after cardiopulmonary resuscitation is highly predictive of outcome.
Madl
C
C
Department of Medicine IV, University of Vienna, Austria.
Grimm
G
G
Kramer
L
L
Yeganehfar
W
W
Sterz
F
F
Schneider
B
B
Kranz
A
A
Schneeweiss
B
B
Lenz
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000191:economics; D005071:Evoked Potentials / Q000502:physiology*; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011336:Probability; D011379:Prognosis; D011930:Reaction Time / Q000502:physiology*; D016896:Treatment Outcome; D014481:United States