Neurological prognostication after cardiac arrest.
Curr Opin Crit Care
; 21(3): 209-14, 2015 Jun.
Article
em En
| MEDLINE
| ID: mdl-25922894
ABSTRACT
PURPOSE OF REVIEW Prediction of neurological prognosis in patients who are comatose after successful resuscitation from cardiac arrest remains difficult. Previous guidelines recommended ocular reflexes, somatosensory evoked potentials and serum biomarkers for predicting poor outcome within 72 âh from cardiac arrest. However, these guidelines were based on patients not treated with targeted temperature management and did not appropriately address important biases in literature. RECENT FINDINGS:
Recent evidence reviews detected important limitations in prognostication studies, such as low precision and, most importantly, lack of blinding, which may have caused a self-fulfilling prophecy and overestimated the specificity of index tests. Maintenance of targeted temperature using sedatives and muscle relaxants may interfere with clinical examination, making assessment of neurological status before 72â h or more after cardiac arrest unreliable.SUMMARY:
No index predicts poor neurological outcome after cardiac arrest with absolute certainty. Prognostic evaluation should start not earlier than 72 âh after ROSC and only after major confounders have been excluded so that reliable clinical examination can be made. Multimodality appears to be the most reasonable approach for prognostication after cardiac arrest.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Encefalopatias
/
Parada Cardíaca
Tipo de estudo:
Etiology_studies
/
Guideline
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article