A prospective analysis of 40 patients with hypoxicischemic coma lasting at least 6 h following sudden cardiac arrest was undertaken. Prediction of poor outcome after hypoxicischemic brain. Predicting outcome from hypoxicischemic comareply jama. Predicting the outcome of a comatose patient at the bedside. Cardiac diseases are the main cause of cardiac arrests 82. To illustrate the spectrum of findings of hypoxic ischemic brain damage in patients resuscitated post cardiac arrest and to use patterns of abnormalities on diffusionweighted imaging dwi and quantitative regional apparent diffusion coefficient adc values to predict their clinical outcome. We evaluate clinical model and then the added value of mri data. Impact of a proactive approach to improve endoflife care. Electroencephalography eeg is widely used to assess neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by interrater variability.
Although some suggest that a glasgow coma scale gcs score 4. The glasgow coma score is a predictor of good outcome in cardiac arrest. Predicting outcome from hypoxiclschemic coma article pdf available in jama the journal of the american medical association 25310. Attempts to prognosticate outcome accurately after cardiac arrest have generated abundant research. Research article open access early clinical signs in. Increased rates of bystander cpr and cardiac defibrillation has led to a rapid increase in successful resuscitations. Hypoxicischaemic brain injury is common and usually due to cardiac arrest or profound hypotension. We studied fluidattenuated inversion recovery flair and diffusionweighted dw imaging in 10 patients. How to assess prognosis after cardiac arrest and therapeutic. Clinical assessment is difficult and so often these days compromised by sedation. Early prognostication of the outcome in resuscitated post cardiac arrest ca patients remains challenging especially if treated with therapeutic hypothermia. Mr imaging in comatose survivors of cardiac resuscitation.
Effect of admission glasgow coma scale motor score on. Outcome from coma caused by cerebral hypoxiaischemia eg, cardiac arrest was compared with serial neurological findings in 210 patients. Aug 16, 2014 electroencephalography eeg is widely used to assess neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by interrater variability. Cognitive and functional outcome after out of hospital. Early prediction of hypoxicischemic brain injury by a new. This work is an extension of previous publications. A prospective clinical and electrophysiologic study. Neurology 2011 jun 14 after neonatal hypoxic ischemic encephalopathy, the presence and severity of central gray matter damage on early brain magnetic resonance imaging accurately predicts adverse motor outcomes at age 2 years. The role of mr imaging as a confirmatory study was investigated. The number of resuscitated cardiac arrest patients suffering from anoxicischemic encephalopathy is considerable. The glasgow coma scale motor score is often used in predicting outcome after hypoxicischemic coma. The most characteristic example of hypoxic ischemic brain damage is produced by cardiac arrest. Absent eeg reactivity strongly predicted an unfavorable outcome in postanoxic coma, and performed as accurate as a synek score 3.
Specificities for predicting an unfavorable outcome were 100% for isoelectric, discontinuous, or dominant delta activity eeg. Transorbital sonography for early prognostication of. Predicting outcome in adults with status epilepticus. Pdf outcome from coma caused by cerebral hypoxiaischemia eg, cardiac arrest was compared with serial. The journal of the american medical association 1985 september 6. However, outcome prediction parameters such as somatosensory evoked potentials need revision because they are based on data predating the implementation of mild therapeutical hypothermia and because data from our own laboratory suggest that they may fail to predict prognosis.
While we fully agree that their data provide a more rational approach for managing patients who sustain hypoxicischemic coma, we wonder about the possibility of a selffulfilling prophecy that potentially confounds these data. We studied fluidattenuated inversion recovery flair and diffusionweighted dw imaging in 10 patients comatose after. A diagnosis of hypoxic brain injury might not always be obvious, as the circumstances that caused the injury might not directly involve the brain, for example having a heart attack or inhaling smoke. Central gray matter damage, the hallmark of term acute perinatal hypoxiaischemia, frequently leads to severe cerebral palsy and sometimes death. Prospective cohort study evaluating the prognostic value. Hypoxic brain damage, also called hypoxicischemic encephalopathy, is a severe consequence of global cerebral ischemia due to cardiac arrest or other causes e. The clinical pattern and outcome depend on the severity of the initial insult, the effectiveness of immediate resuscitation and transfer, and the postresuscitation management on the intensive care unit. Predicting clinical outcome in comatose cardiac arrest patients using. A literature search of medline was performed using the search terms hie and. The prognosis of comatose survivors is determined by clinical examination. Clinical trials showed that 27% of posthypoxic coma patients regained. A hypoxic brain injury is a type of brain injury that occurs when there is a disruption in supply of oxygen to the brain. Hypoxicischemic brain injury hibi after cardiac arrest commonly results in neurological injury and long term dysfunction, with outcomes ranging from coma and vegetative states to functional disability with various degrees of dependence. Outcome of severe anoxicischemic brain injury in children.
Other serious methodological drawbacks are as follows. A multicenter prospective observational study was performed between march 2012 and april 2015 in two european tertiary nicus. Although some suggest that a glasgow coma scale gcs score outcome, 3,4 others have demonstrated that gcs at admission was a poor predictor. A prospective analysis of 40 patients with hypoxic ischemic coma lasting at least 6 h following sudden cardiac arrest was undertaken. Predicting clinical outcome in comatose cardiac arrest. Does hypothermia influence the predictive value of bilateral absent n20 after cardiac arrest. Diffusionweighted imaging dwi can detect acute and subacute brain abnormalities following global cerebral hypoxia. These 3 last features were constantly associated to unfavorable outcome. In normothermic infants, a normal aeeg during the first 6 hours after birth has a sensitivity of 89% and a positive predictive value ppv of 96. The outcome of 25 children who had anoxic or ischemic brain injuries at 2 months to 14 years of age is reported. Predicting motor outcome and death in term hypoxicischemic. Outcome and prognosis of hypoxic brain damage patients. Prognostication in anoxic brain injury kim phung l. To this end, we searched the pubmed, embase, and cochrane library databases for studies that examine.
Predicting outcome from hypoxiclschemic coma jama network. Longterm outcome data and prognostic factors for either poor or good outcome are lacking. Predicting outcome from hypoxicischemic coma pubmed. This research paper is aimed at evaluating the predictive role of a default panel of oxidative stress os biomarkers for the early identification of infants at high risk of hie and their validation through the correlation with mri findings. The aim of this exploratory study is to use a decision tree model to find clinical and mri associates of severe disability and death in this condition. Download pdf 718k download meta ris compatible with endnote, reference manager, procite, refworks bib tex. Therefore, dwi can be used to predict the outcomes of hibi. View or download all content the institution has subscribed to. Electroencephalography eeg for neurological prognostication. Cognitive and functional outcome after out of hospital cardiac arrest volume 17 issue 2 michael p.
Jan 01, 2010 hypoxic ischemic brain injury hibi after cardiac arrest commonly results in neurological injury and long term dysfunction, with outcomes ranging from coma and vegetative states to functional disability with various degrees of dependence. We evaluated the accuracy of early brain mri for predicting death, the presence and severity of motor impairment, and. Prospective cohort study evaluating the prognostic value of. Outcome from coma caused by cerebral hypoxiaischemia eg, cardiac. Impact of a proactive approach to improve endoflife care in. How to predict neurological outcomes in hypoxicischemic encephalopathy. Persistent seizure activity following hypoxicischemic encephalopathy is an independent predictor of poor outcome with a mortality of up to 100%, mainly because of its largely irreversible brain damage.
Median adcs were measured in these regions and in the whole brain and were compared with a twotailed wilcoxon test as a function of clinical outcome. Predicting the neurologic outcome of children after a hypoxicischemic event continues to be a challenge for intensivists and pediatric neurologists. Predicting the outcome from hypoxicischemic coma jama. Frontiers exploratory use of decision tree analysis in. Predicting motor outcome and death in term hypoxic. If a babys oxygen supply is dramatically or entirely cut off, their lasting brain. In the sept 6, 1985, issue of the journal, dr black 1 expressed major reservations about applying the scheme for predicting the outcome of hypoxicischemic coma suggested by levy et al. Comparison of apache ii, mees and glasgow coma scale in.
To assess the impact of a proactive case finding approach to endoflife care for critically ill patients experiencing global cerebral ischemia gci after cardiopulmonary resuscitation and multiple organ system failure mosf in comparison to historical control subjects. All patients were unconscious for at least 24 hours. The longterm outcomes of babies born with hypoxicischemic encephalopathy hie can vary widely, from no lasting effects to extensive physical and intellectual impairment requiring 24hour care. The most characteristic example of hypoxicischemic brain damage is produced by cardiac arrest.
Neurology 2011 jun 14 after neonatal hypoxicischemic encephalopathy, the presence and severity of central gray matter damage on early brain magnetic resonance imaging accurately predicts adverse motor outcomes at age 2 years. Although clinical examination remains the preeminent tool to predict the chances of recovery after cardiac resuscitation, a number of. Neurological sequelae of hypoxicischemic brain injury. Accurate prediction of the neurological outcome following hypoxicischemic brain injury hibi remains difficult. Although we present a heterogeneous population it is an accurate reflection of clinical practice.
Longterm outcomes of hypoxicischemic encephalopathy. Predictive value of glasgow coma score for awakening after outofhospital cardiac arrest. Cerebral resuscitation study group of the belgian society for intensive care. Quantitative analysis of the loss of distinction between gray. In a recent study on 111 icu patients with rse, hypoxicischemic en. How severely hie affects an individual depends on a variety of factors, including. The purpose of the present study was to assess the.
The precision with which these outcomes can be determined from neonatal imaging has not been fully explored. Mar 08, 1985 predicting outcome from hypoxic ischemic coma. In a recent issue of the journal, levy et al 1 have presented a summary of their work on the outcome of coma in 210 patients with brain hypoxia or ischemia. Exploratory use of decision tree analysis in classification. Predicting outcomes after neonatal hypoxicischemic injury. Research article open access early clinical signs in neonates. The patients, all of whom had preserved brainstem function, were studied electrophysiologically with electroencephalography eeg, and median nerve somatosensory evoked potentials seps within 48 h to establish prognostic indices. Prediction of poor outcome within the first 3 days of postanoxic coma. This retrospective study included 93 patients with hypoxic brain damage undergoing neurological early rehabilitation length of stay. Jun 17, 2015 the prevalence of patients suffering from hypoxic brain damage is increasing. Predicting outcome in children with hypoxic ischemic.
Early laboratory indicators of poor prognosis such as evoked potentials have low sensitivity. Predicting clinical outcome in comatose cardiac arrest patients. Within this cohort, 200 patients were comatose secondary to hypoxicischemic brain injury. The american clinical neurophysiology society acns has recently proposed a standardized eegterminology for critical care to address these limitations. Backgroundprognostication following hypoxic ischemic encephalopathy brain injury is important for clinical management. Predicting outcome in children with hypoxic ischemic encephalopathy article in pediatric critical care medicine 91. Hypoxicischemic encephalopathy hie after perinatal asphyxia is a condition in which serum concentrations of brainspecific biochemical markers may be elevated. Judicious care should be exerted when using this variable in predicting outcome in patients with coma following hypotension since borderzone infarction can obscure the clinical picture. Predicting clinical outcome in comatose cardiac arrest patients using early. Predicting outcome from hypoxicischemic coma jama jama.
We evaluated the accuracy of early brain mri for predicting death, the presence and severity of motor impairment, and ability to. Prognostication in anoxic brain injury show all authors. Jul 18, 2018 amplitudeintegrated eeg is useful in predicting neurodevelopmental outcome in fullterm infants with hypoxic ischemic encephalopathy. Hypoxic ischemic encephalopathy hie is common in children, and providing accurate and timely prognostic information is important in determining the appropriate level of care. Prognosis of anoxicischemic encephalopathy palliative care. Clinical assessment of patients with hibi is difficult 10 and often depends on the support of ancillary investigations to guide prognosis and management. Emergency departments, worldwide, see coma from opioids, anoxicischaemic injury after cardiopulmonary resuscitation, traumatic brain injury, status. Mri is the optimal modality for the early evaluation of the site and severity of brain injury and the prediction of outcomes in infants with hypoxicischemic encephalopathy hie.