Prediction of neurological outcome after cardiac arrest

Background

Modern resuscitation helps to save many lives across the world. Unfortunately, despite the great development and sophistication of emergency systems, lots of patients die, and many of the survivors persist with different degrees of neurological handicaps. Early determination of outcome after cardiopulmonary resuscitation (CPR) is a common problem with clinical, ethical, economic and social consequences.

Objective

To predict cerebral outcome after CA by clinical neurological examination.

Methods

We conducted a prospective study, started in August 2000, including all patients that had a return of spontaneous circulation (ROSC) after CA. All the resuscitation attempts were registered using a form based in the Utstein Style template. A neurological evaluation was performed using a protocol that included GCS, brain steam reflex, spontaneous eyes movements, spontaneous mobility, breathing and seizures immediately after CPR; at 12, 24, 48, 72 hours, 8 days later and at discharge.

Results

Twenty-three patients were included in the protocol, corresponding to 68 resuscitation attempts (corresponding to a ROSC of 47%). We found 72 hours the better time for evaluation because before that most of the patients were sedated. All patients with either GCS < 5, absence of one or more brain steam reflex, in any time of evaluation died without any neurological recovery. The patients that had at the third day a GCS > 9 and or oriented eye movements and or oculocefalic reflexes were discharged from hospital in 63,6% of cases. Seven patients, all from the last group of patients, had a complete neurological recovery at discharge. The mean duration of cardiac arrest was 4.7 min in group with GCS score superior to 13; 11 min in the group with GCS score between 5 and 13, and 12 min in group with GCS inferior to 5.

Conclusion

Neurological prognostic depends on cardiac arrest duration. In our study the existence of a GCS < 5; absence of spontaneous eyes movement or absence of brains reflex at any time after cardiopulmonary resuscitation was indicative of poor neurological and overall outcome.