Prognostication after cardiac arrest and hypothermia

A prospective study

Andrea O. Rossetti, Mauro Oddo, Giancarlo Logroscino, Peter W Kaplan

Research output: Contribution to journalArticle

Abstract

Objective: Current American Academy of Neurology (AAN) guidelines for outcome prediction in comatose survivors of cardiac arrest (CA) have been validated before the therapeutic hypothermia era (TH). We undertook this study to verify the prognostic value of clinical and electrophysiological variables in the TH setting. Methods: A total of 111 consecutive comatose survivors of CA treated with TH were prospectively studied over a 3-year period. Neurological examination, electroencephalography (EEG), and somatosensory evoked potentials (SSEP) were performed immediately after TH, at normothermia and off sedation. Neurological recovery was assessed at 3 to 6 months, using Cerebral Performance Categories (CPC). Results: Three clinical variables, assessed within 72 hours after CA, showed higher false-positive mortality predictions as compared with the AAN guidelines: incomplete brainstem reflexes recovery (4% vs 0%), myoclonus (7% vs 0%), and absent motor response to pain (24% vs 0%). Furthermore, unreactive EEG background was incompatible with good long-term neurological recovery (CPC 1-2) and strongly associated with in-hospital mortality (adjusted odds ratio for death, 15.4; 95% confidence interval, 3.3-71.9). The presence of at least 2 independent predictors out of 4 (incomplete brainstem reflexes, myoclonus, unreactive EEG, and absent cortical SSEP) accurately predicted poor long-term neurological recovery (positive predictive value = 1.00); EEG reactivity significantly improved the prognostication. Interpretation: Our data show that TH may modify outcome prediction after CA, implying that some clinical features should be interpreted with more caution in this setting as compared with the AAN guidelines. EEG background reactivity is useful in determining the prognosis after CA treated with TH.

Original languageEnglish (US)
Pages (from-to)301-307
Number of pages7
JournalAnnals of Neurology
Volume67
Issue number3
DOIs
StatePublished - Mar 2010

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Induced Hypothermia
Heart Arrest
Hypothermia
Electroencephalography
Prospective Studies
Myoclonus
Somatosensory Evoked Potentials
Guidelines
Neurology
Coma
Brain Stem
Reflex
Survivors
Neurologic Examination
Hospital Mortality
Odds Ratio
Confidence Intervals
Pain
Mortality

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Prognostication after cardiac arrest and hypothermia : A prospective study. / Rossetti, Andrea O.; Oddo, Mauro; Logroscino, Giancarlo; Kaplan, Peter W.

In: Annals of Neurology, Vol. 67, No. 3, 03.2010, p. 301-307.

Research output: Contribution to journalArticle

Rossetti, Andrea O. ; Oddo, Mauro ; Logroscino, Giancarlo ; Kaplan, Peter W. / Prognostication after cardiac arrest and hypothermia : A prospective study. In: Annals of Neurology. 2010 ; Vol. 67, No. 3. pp. 301-307.
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