Prediction of neurological outcome after cardiopulmonary resuscitation

In 231 patients with circulatory arrest of primary cardiovascular or pulmonary aetiology guidelines were established for predicting neurological outcome within the first year after cardiopulmonary resuscitation. Outcome measures were brain death, persistent unconsciousness, persistent disability after awakening and complete recovery. A total of 116 patients remained unconscious while 115 regained consciousness. Brain stem areflexia with apnoea (brain death) was demonstrated in 40 patients. No other finding per se could predict a specific outcome. The time for recovery of individual neurological functions seemed to be the key to prognostication. Testing the caloric vestibular reflex or stereotypic reactivity thus differentiated patients regaining consciousness from those remaining unconscious, with positive predictive values of 0.79 and 0.77 at 1 h and negative values of 1.0 and 0.97 at 24 h as compared with 50/50 prior odds. The presence of speech at 24 h or the ability to cope with personal necessities at 72 h predicted complete recovery with positive predictive values of 0.91 and 0.92 as compared with prior odds of 0.17, whereas, the negative predictive values never exceeded prior odds of 0.83.