title: Neurological consequences of cardiac arrest: where do we stand?
abstract: With increasing public education in basic life support and with the widespread use of automated defibrillators, post-cardiac arrest comatose patients represent a growing part of ICU admissions. However the prognosis remains very poor and only a very low proportion of these resuscitated patients will recover and will leave the hospital without major neurological impairments. Neurological dysfunction predominantly includes disorders of consciousness, and may also include other manifestations such as seizures, myoclonus status epilepticus and other forms of movement disorders including post-anoxic myoclonus. In the most severe cases, coma may be irreversible or evolve towards a minimally conscious state, a vegetative state or even brain death. These severe conditions represent by far the leading cause of mortality and disability in such patients. Currently, early use of mild therapeutic hypothermia is the only treatment that demonstrated its ability to decrease neurological consequences and to improve the prognosis. Prognostication outcome is still mainly based on a rigorous clinical evaluation coupled with neuro-physiological investigations, but brain functional imaging could become a valuable tool in the near future. Clinical research focusing on survivors should be strongly encouraged in order to assess the mid- and long-terms outcome of survivors and to evaluate the impact of new treatments or strategies.
authors.affiliation: Medical Intensive Care Unit, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Geri
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care, Henri-Mondor Hospital, Assistance publique des Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Faculté de médecine, université Paris Est, 8, avenue du Général-Sarrail, 94000 Créteil, France.
authors.forename: N
authors.initials: N
authors.lastname: Mongardon
authors.affiliation: Medical Intensive Care Unit, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Daviaud
authors.affiliation: Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Empana
authors.affiliation: Emergency Department, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Dumas
authors.affiliation: Medical Intensive Care Unit, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France. Electronic address: alain.cariou@cch.aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Cariou
mesh_terms: D001925:Brain Damage, Chronic / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology; D001926:Brain Death; D016887:Cardiopulmonary Resuscitation; D003244:Consciousness Disorders / Q000209:etiology*; D003422:Critical Care; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced; D002534:Hypoxia, Brain / Q000209:etiology*; D018447:Medical Futility / Q000941:ethics; D018696:Neuroprotective Agents / Q000627:therapeutic use; D011379:Prognosis; D011788:Quality of Life; D012640:Seizures / Q000209:etiology; D013226:Status Epilepticus / Q000209:etiology; D017741:Survivors; D016896:Treatment Outcome
chemical_list: D018696:Neuroprotective Agents
keywords: Arrêt cardiaque; Cardiac arrest; Cardio-pulmonary resuscitation; Hypothermie thérapeutique; Prognostication; Réanimation cardiopulmonaire; Therapeutic hypothermia; Évaluation pronostique