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Critical Care
Published in: Critical Care 6/2006

01-12-2006 | Commentary

Optimizing neurologic prognosis after cardiac arrest

Author: David Tirschwell

Published in: Critical Care | Issue 6/2006

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Abstract

Neurologic disability is a feared outcome of resuscitation from cardiac arrest. The study by Rech and colleagues in the previous issue of Critical Care describes the use of neuron-specific enolase to inform an early prognosis in patients who survived in-hospital cardiac arrest. In their study 'none of the patients had a DNR order and there was no limitation of life support.' As a result, 10% of patients remained in a vegetative state at 6 months, a higher percentage than in other recent studies. The existence of a population of patients in which all are fully supported without withholding care or withdrawal of care may represent an important research opportunity. High neuron-specific enolase levels have been reported in patients that awoke and seem to occur in studies with a higher percentage of patients in a vegetative state at follow-up (more uniform support). If a comprehensive set of clinical, electrophysiological, biochemical and imaging measures could be obtained in a uniform manner in a cohort of patients without limitations in care, a more objective set of comprehensive prognostic indicators could be obtained. A focused international consortium is called for.
Literature
1.
Rech TH, Vieira SRR, Nagel F, Brauner JS, Scalco R: Serum neuron-specific enolase as early predictor of outcome after in-hospital cardiac arrest: a cohort study. Crit Care 2006, 10: R133. 10.1186/cc5046PubMedCentralCrossRefPubMed
2.
Donatelli LA, Geocadin RG, Williams MA: Ethical issues in critical care and cardiac arrest: clinical research, brain death, and organ donation. Semin Neurol 2006, 26: 452-459. 10.1055/s-2006-948326CrossRefPubMed
3.
Pope John P II: Address of Pope John Paul II to the participants in the International Congress on 'Life-sustaining treatments and vegetative state: scientific advances and ethical dilemmas', Saturday, 20 March 2004. NeuroRehabilitation 2004, 19: 273-275.
4.
Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, Ledoux D, Lippert A, Maia P, Phelan D, et al.: End-of-life practices in European intensive care units: the Ethicus Study. JAMA 2003, 290: 790-797. 10.1001/jama.290.6.790CrossRefPubMed
5.
Geocadin RG, Buitrago MM, Torbey MT, Chandra-Strobos N, Williams MA, Kaplan PW: Neurologic prognosis and withdrawal of life support after resuscitation from cardiac arrest. Neurology 2006, 67: 105-108. 10.1212/01.wnl.0000223335.86166.b4CrossRefPubMed
6.
Longstreth WT Jr, Fahrenbruch CE, Olsufka M, Walsh TR, Copass MK, Cobb LA: Randomized clinical trial of magnesium, diazepam, or both after out-of-hospital cardiac arrest. Neurology 2002, 59: 506-514.CrossRefPubMed
7.
Zandbergen EG, Hijdra A, Koelman JH, Hart AA, Vos PE, Verbeek MM, de Haan RJ, PROPAC Study Group: Prediction of poor outcome within the first 3 days of postanoxic coma. Neurology 2006, 66: 62-68. 10.1212/01.wnl.0000191308.22233.88CrossRefPubMed
8.
Zingler VC, Krumm B, Bertsch T, Fassbender K, Pohlmann-Eden B: Early prediction of neurological outcome after cardiopulmonary resuscitation: a multimodal approach combining neurobiochemical and electrophysiological investigations may provide high prognostic certainty in patients after cardiac arrest. Eur Neurol 2003, 49: 79-84. 10.1159/000068503CrossRefPubMed
9.
Martens P: Serum neuron-specific enolase as a prognostic marker for irreversible brain damage in comatose cardiac arrest survivors. Acad Emerg Med 1996, 3: 126-131.CrossRefPubMed
10.
Pfeifer R, Borner A, Krack A, Sigusch HH, Surber R, Figulla HR: Outcome after cardiac arrest: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale. Resuscitation 2005, 65: 49-55. 10.1016/j.resuscitation.2004.10.011CrossRefPubMed
11.
Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S: Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006, 67: 203-210. 10.1212/01.wnl.0000227183.21314.cdCrossRefPubMed
Metadata
Title
Optimizing neurologic prognosis after cardiac arrest
Author
David Tirschwell
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc5085

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