Neurologic prognosis and withdrawal of life support after resuscitation from cardiac arrest
Neurologic prognosis and withdrawal of life support after resuscitation from cardiac arrest
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DOI：
10.1212/01.wnl.0000223335.86166.b4
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发表时间：
2006-07-11
期刊：
影响因子：
9.9
通讯作者：
Kaplan, P. W.
中科院分区：
文献类型：
--
作者：
Geocadin, R. G.;Buitrago, M. M.;Kaplan, P. W.
目的：研究神经功能障碍对心脏骤停后复苏的昏迷患者决定撤销生命维持治疗（LST）的影响。研究方法：作者前瞻性研究了一个连续系列的复苏后昏迷的患者转介神经系统诊断在一个单一的中心，为期4年。对于大多数患者，由于早期死亡或快速恢复意识，未寻求神经系统诊断。根据格拉斯哥昏迷评分（GCS）和脑干反射评分（BRS），以及脑电图和皮层诱发电位（CEP），将预后分为良性、不确定和恶性。结局如下：存活者（S组）、脑或心源性死亡（D组）和因停止生命维持治疗而死亡（W组）。在W组中，通过EEG和CEP分级分析LST撤销的时间间隔。结果：58例患者中，S组10例，D组8例，W组40例。所有组的初始中位GCS和BRS相似，在S组中观察到显著改善，但在D组或W组中未观察到显著改善。在W组中，CEP分级与决定停用LST前继续治疗的中位持续时间相关：良性CEP为7天，不确定CEP为2天，恶性CEP为1天，p = 0.0004。结论：在心脏骤停复苏后早期神经功能恢复差的患者中，医生似乎使用皮层诱发电位分级来估计预后。皮层诱发电位分级与神经系统检查无改善后停止生命维持治疗的等待时间相关。
Objective: To study the impact of neurologic prognostication on the decision to withdraw life-sustaining therapies (LST) in comatose patients resuscitated after cardiac arrest. Methods: The authors prospectively studied a consecutive series of post-resuscitation comatose patients referred for neurologic prognostication at a single center for 4 years. For most patients, neurologic prognostication was not sought due to early death or rapid return to consciousness. Prognostication was based on Glasgow Coma Score (GCS) and Brainstem Reflex Score (BRS), with EEG and cortical evoked potentials (CEP), which were graded as benign, uncertain, and malignant. The outcomes were as follows: survivors (Group S), brain or cardiac death (Group D), and death from withdrawal of life sustaining therapy (Group W). In Group W, the time interval to withdrawal of LST was analyzed by EEG and CEP grades. Results: Of 58 patients studied, 10 were in Group S, 8 in Group D, and 40 in Group W. Initial median GCS and BRS was similar for all groups with significant improvement noted in Group S, but not in Group D or Group W. In Group W, CEP grade correlated with the median duration of continued therapy before a decision to withdraw LST: 7 days for benign CEP, 2 days for uncertain CEP, and 1 day for malignant CEP, p = 0.0004. Conclusion: In patients with poor neurologic recovery early after resuscitation from cardiac arrest, physicians appear to use the cortical evoked potential grade to estimate prognosis. Cortical evoked potential grade correlated with the waiting time until life sustaining therapies were withdrawn after no improvement in neurologic examination was seen.