Predicting Outcome after Cardiopulmonary Arrest in Therapeutic Hypothermia Patients: Clinical, Electrophysiological and Imaging Prognosticators

Detalhes bibliográficos
Autor(a) principal: Maia, Bruno
Data de Publicação: 2013
Outros Autores: Roque, Rafael, Amaral-Silva, Alexandre, Lourenço, Sónia, Bento, Luís, Alcântara, João
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/203
Resumo: Introduction: Predicting outcome in comatose survivors of cardiac arrest is based on data validated by guidelines that were established before the era of therapeutic hypothermia. We sought to evaluate the predictive value of clinical, electrophysiological and imaging data on patients submitted to therapeutic hypothermia. Materials and Methods: A retrospective analysis of consecutive patients receiving therapeutic hypothermia during years 2010 and 2011 was made. Neurological examination, somatosensory evoked potentials, auditory evoked potentials, electroencephalography and brain magnetic resonance imaging were obtained during the first 72 hours. Glasgow Outcome Scale at 6 months, dichotomized into bad outcome (grades 1 and 2) and good outcome (grades 3, 4 and 5), was defined as the primary outcome. Results: A total of 26 patients were studied. Absent pupillary light reflex, absent corneal and oculocephalic reflexes, absent N20 responses on evoked potentials and myoclonic status epilepticus showed no false-positives in predicting bad outcome. A malignant electroencephalographic pattern was also associated with a bad outcome (p = 0.05), with no false-positives. Two patients with a good outcome showed motor responses no better than extension (false-positive rate of 25%, p = 0.008) within 72 hours, both of them requiring prolonged sedation. Imaging findings of brain ischemia did not correlate with outcome. Discussion: Absent pupillary, corneal and oculocephalic reflexes, absent N20 responses and a malignant electroencephalographic pattern all remain accurate predictors of poor outcome in cardiac arrest patients submitted to therapeutic hypothermia. Conclusion: Prolonged sedation beyond the hypothermia period may confound prediction strength of motor responses.
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spelling Predicting Outcome after Cardiopulmonary Arrest in Therapeutic Hypothermia Patients: Clinical, Electrophysiological and Imaging PrognosticatorsPrognóstico após Paragem Cardio-Respiratória em Doentes Submetidos a Hipotermia Terapêutica: Factores Clínicos, Electrofisiológicos e ImagiológicosIntroduction: Predicting outcome in comatose survivors of cardiac arrest is based on data validated by guidelines that were established before the era of therapeutic hypothermia. We sought to evaluate the predictive value of clinical, electrophysiological and imaging data on patients submitted to therapeutic hypothermia. Materials and Methods: A retrospective analysis of consecutive patients receiving therapeutic hypothermia during years 2010 and 2011 was made. Neurological examination, somatosensory evoked potentials, auditory evoked potentials, electroencephalography and brain magnetic resonance imaging were obtained during the first 72 hours. Glasgow Outcome Scale at 6 months, dichotomized into bad outcome (grades 1 and 2) and good outcome (grades 3, 4 and 5), was defined as the primary outcome. Results: A total of 26 patients were studied. Absent pupillary light reflex, absent corneal and oculocephalic reflexes, absent N20 responses on evoked potentials and myoclonic status epilepticus showed no false-positives in predicting bad outcome. A malignant electroencephalographic pattern was also associated with a bad outcome (p = 0.05), with no false-positives. Two patients with a good outcome showed motor responses no better than extension (false-positive rate of 25%, p = 0.008) within 72 hours, both of them requiring prolonged sedation. Imaging findings of brain ischemia did not correlate with outcome. Discussion: Absent pupillary, corneal and oculocephalic reflexes, absent N20 responses and a malignant electroencephalographic pattern all remain accurate predictors of poor outcome in cardiac arrest patients submitted to therapeutic hypothermia. Conclusion: Prolonged sedation beyond the hypothermia period may confound prediction strength of motor responses.Introdução: A determinação do prognóstico em sobreviventes comatosos de paragem cárdio-respiratória baseia-se em evidência adquirida sobretudo antes do advento da hipotermia terapêutica. O nosso objectivo é avaliar a capacidade preditiva de dados clínicos, electrofisiológicos e imagiológicos após a hipotermia terapêutica. Materiais e Métodos: Análise retrospectiva e consecutiva de doentes que foram tratados com hipotermia durante os anos de 2010 e 2011. Foram obtidos dados relativamente ao exame neurológico, potenciais evocados somatossensitivos e auditivos, electroencefalograma e ressonância magnética crânio-encefálica, nas primeiras 72 horas após o evento. O outcome definido foi a escala Glasgow Outcome Scale dicotomizada em mau prognóstico (pontuações 1 e 2) e bom prognóstico (pontuações 3, 4 e 5). Resultados: Estudados no total 26 doentes. Reflexos pupilares, corneanos e oculocefálicos abolidos, ausência de respostas N20 nos potenciais evocados somatossensitivos, estado de mal mioclónico e um padrão ‘maligno’ na electroencefalografia relacionaram-se com mau prognóstico, sem falsos-positivos (p = 0,05). Dois doentes classificados com bom outcome demonstraram respostas motoras ausentes ou em extensão nas primeiras 72 horas, originando uma taxa de falsos-positivos de 25% para este parâmetro (p = 0,008). Ambos requereram sedação até às 72 horas. A presença de isquémia na ressonância não teve relação significativa com o outcome. Discussão: A abolição dos reflexos pupilares, corneanos e oculocefálicos, a ausência de respostas N20 nos potenciais evocados, estado de mal mioclónico e um padrão electroencefalográfico ‘maligno’ mantêm-se parâmetros de mau prognóstico válidos em doentes submetidos a hipotermia terapêutica. Conclusão: A necessidade de sedação nestes doentes pode diminuir a capacidade prognóstica das respostas motoras.Ordem dos Médicos2013-06-05info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/203oai:ojs.www.actamedicaportuguesa.com:article/203Acta Médica Portuguesa; Vol. 26 No. 2 (2013): March-April; 93-97Acta Médica Portuguesa; Vol. 26 N.º 2 (2013): Março-Abril; 93-971646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/203https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/203/3220Maia, BrunoRoque, RafaelAmaral-Silva, AlexandreLourenço, SóniaBento, LuísAlcântara, Joãoinfo:eu-repo/semantics/openAccess2022-12-20T10:55:52Zoai:ojs.www.actamedicaportuguesa.com:article/203Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:16:23.346215Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Predicting Outcome after Cardiopulmonary Arrest in Therapeutic Hypothermia Patients: Clinical, Electrophysiological and Imaging Prognosticators
Prognóstico após Paragem Cardio-Respiratória em Doentes Submetidos a Hipotermia Terapêutica: Factores Clínicos, Electrofisiológicos e Imagiológicos
title Predicting Outcome after Cardiopulmonary Arrest in Therapeutic Hypothermia Patients: Clinical, Electrophysiological and Imaging Prognosticators
spellingShingle Predicting Outcome after Cardiopulmonary Arrest in Therapeutic Hypothermia Patients: Clinical, Electrophysiological and Imaging Prognosticators
Maia, Bruno
title_short Predicting Outcome after Cardiopulmonary Arrest in Therapeutic Hypothermia Patients: Clinical, Electrophysiological and Imaging Prognosticators
title_full Predicting Outcome after Cardiopulmonary Arrest in Therapeutic Hypothermia Patients: Clinical, Electrophysiological and Imaging Prognosticators
title_fullStr Predicting Outcome after Cardiopulmonary Arrest in Therapeutic Hypothermia Patients: Clinical, Electrophysiological and Imaging Prognosticators
title_full_unstemmed Predicting Outcome after Cardiopulmonary Arrest in Therapeutic Hypothermia Patients: Clinical, Electrophysiological and Imaging Prognosticators
title_sort Predicting Outcome after Cardiopulmonary Arrest in Therapeutic Hypothermia Patients: Clinical, Electrophysiological and Imaging Prognosticators
author Maia, Bruno
author_facet Maia, Bruno
Roque, Rafael
Amaral-Silva, Alexandre
Lourenço, Sónia
Bento, Luís
Alcântara, João
author_role author
author2 Roque, Rafael
Amaral-Silva, Alexandre
Lourenço, Sónia
Bento, Luís
Alcântara, João
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Maia, Bruno
Roque, Rafael
Amaral-Silva, Alexandre
Lourenço, Sónia
Bento, Luís
Alcântara, João
description Introduction: Predicting outcome in comatose survivors of cardiac arrest is based on data validated by guidelines that were established before the era of therapeutic hypothermia. We sought to evaluate the predictive value of clinical, electrophysiological and imaging data on patients submitted to therapeutic hypothermia. Materials and Methods: A retrospective analysis of consecutive patients receiving therapeutic hypothermia during years 2010 and 2011 was made. Neurological examination, somatosensory evoked potentials, auditory evoked potentials, electroencephalography and brain magnetic resonance imaging were obtained during the first 72 hours. Glasgow Outcome Scale at 6 months, dichotomized into bad outcome (grades 1 and 2) and good outcome (grades 3, 4 and 5), was defined as the primary outcome. Results: A total of 26 patients were studied. Absent pupillary light reflex, absent corneal and oculocephalic reflexes, absent N20 responses on evoked potentials and myoclonic status epilepticus showed no false-positives in predicting bad outcome. A malignant electroencephalographic pattern was also associated with a bad outcome (p = 0.05), with no false-positives. Two patients with a good outcome showed motor responses no better than extension (false-positive rate of 25%, p = 0.008) within 72 hours, both of them requiring prolonged sedation. Imaging findings of brain ischemia did not correlate with outcome. Discussion: Absent pupillary, corneal and oculocephalic reflexes, absent N20 responses and a malignant electroencephalographic pattern all remain accurate predictors of poor outcome in cardiac arrest patients submitted to therapeutic hypothermia. Conclusion: Prolonged sedation beyond the hypothermia period may confound prediction strength of motor responses.
publishDate 2013
dc.date.none.fl_str_mv 2013-06-05
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/203/3220
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dc.publisher.none.fl_str_mv Ordem dos Médicos
publisher.none.fl_str_mv Ordem dos Médicos
dc.source.none.fl_str_mv Acta Médica Portuguesa; Vol. 26 No. 2 (2013): March-April; 93-97
Acta Médica Portuguesa; Vol. 26 N.º 2 (2013): Março-Abril; 93-97
1646-0758
0870-399X
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