title: [Neurologic prognosis after cardiocirculatory arrest outside the hospital].
abstract: OBJECTIVE
  To detect clinical signs and times of evaluation able to identify patients with good neurologic prognosis after out-of-hospital cardiac arrest.
  
  
  METHODS
  Retrospective study with 6 months-2 years of follow-up.
  
  
  METHODS
  General intensive care unit, from 1993 to 1995.
  
  
  METHODS
  Twenty-three patients aged 18-80 years, admitted with coma after out-of-hospital cardiac arrest, who survived at least 24 hours, without concomitant neurologic disorders.
  
  
  METHODS
  Neurologic outcome classification in three categories: complete neurologic recovery (A), moderate to severe disability (B), death without regained consciousness (C); A and B groups of patients are considered together as a "good neurologic outcome" group.
  
  
  METHODS
  Evaluation of some neurological parameters (GCS, motor response to pain, spontaneous motility, cranial nerve reflexes, spontaneous breathing, seizures) 6 hours (t0), 24 hours (t1), 72 hours (t2) and 7 days (t3) after arrest.
  
  
  RESULTS
  Patients with good prognosis are identified with 100% sensitivity from the following parameters: at t0 none; at t1 motor response to pain, GCS > 4, absence of seizures; at t2 the former parameters, spontaneous breathing, brain stem reflexes, normal pupils; at t3 all the former parameters and spontaneous motility. Specificity is greater than 50% only for motor response to pain and GCS > 4.
  
  
  CONCLUSIONS
  It is mostly impossible to state a neurologic prognosis in the first hours after cardiac arrest. The single predictor with the most reliable prognostic value is motor response to pain which allows, if present, to identify all the patients with a good prognosis as early as 24 hours after arrest.
authors.affiliation: Istituto di Anestesia e Rianimazione, IRCCS Ospedale Maggiore Policlinico, Milano.
authors.forename: D
authors.initials: D
authors.lastname: Codazzi
authors.forename: S
authors.initials: S
authors.lastname: Pifferi
authors.forename: M
authors.initials: M
authors.lastname: Savioli
authors.forename: M
authors.initials: M
authors.lastname: Langer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology*; D010045:Outpatients; D011379:Prognosis; D012189:Retrospective Studies