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Postanoxic coma: how (long) should we treat?

E G J Zandbergen1

  • 1Ziekenhuis Rijnstate, Wagnerlaan, Arnhem, The Netherlands. ezandbergen@alysis.nl

European Journal of Anaesthesiology. Supplement
|April 17, 2008
PubMed
Summary
This summary is machine-generated.

Predicting outcomes after postanoxic coma is challenging. Absent somatosensory evoked potentials and elevated neuron-specific enolase are reliable indicators of poor prognosis in patients with brain anoxia.

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Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Neurology

Background:

  • Postanoxic coma, often resulting from cardiac arrest, leads to unconsciousness due to global brain anoxia.
  • While outcomes are generally poor, predicting recovery remains difficult, with reported consciousness recovery rates varying widely.
  • Identifying reliable predictors of poor outcome is crucial for patient management and prognostication.

Purpose of the Study:

  • To identify reliable clinical and neurophysiological factors for predicting poor outcomes in patients with postanoxic coma.
  • To evaluate the predictive value of neurological examination, neurophysiological tests, and biochemical markers.

Main Methods:

  • Review of studies focusing on outcome prediction in postanoxic coma, including the PROPAC study (407 patients).
  • Analysis of neurological examination findings, somatosensory evoked potentials (SEPs), and serum neuron-specific enolase (NSE) levels.
  • Inclusion of factors identified in the 2006 American Practice Parameter on anoxic-ischaemic coma.

Main Results:

  • Bilaterally absent early cortical response in median nerve somatosensory evoked potentials is a highly reliable predictor of no consciousness recovery.
  • Serum neuron-specific enolase levels above 33 microg L(-1) demonstrated similar reliability in predicting poor outcomes.
  • Key predictors of poor outcome (death, coma, or severe disability at 6 months) include myoclonic status epilepticus, absent pupillary and corneal reflexes, absent or extensor motor response to pain, and absent somatosensory evoked potentials.

Conclusions:

  • Absent somatosensory evoked potentials and elevated serum neuron-specific enolase are the most reliable predictors of poor outcome in postanoxic coma.
  • Clinical factors such as absent pupillary and corneal reflexes, and motor response to pain, also reliably predict poor outcomes.
  • Neuroimaging and other biochemical parameters currently yield inconclusive results for outcome prediction.