Outcome and prognosis of hypoxic brain damage patients. The precision with which these outcomes can be determined from neonatal imaging has not been fully explored. Although clinical examination remains the preeminent tool to predict the chances of recovery after cardiac resuscitation, a number of. In patients with postcardiac arrest coma, 4 clinical signs absent corneal and pupilary reflexes, absent motor response, and absent withdrawal to pain assessed 24 hours after cardiac arrest as well as absent motor response assessed 72 hours after the cardiac arrest are precise and accurate for predicting a poor outcome. A poor neurological outcomedefined as death from neurological cause, persistent vegetative state, or severe neurological disabilitycan be predicted in these patients by assessing the severity of hibi. The criteria predict a patients longterm neurological outcome within the first few days after cardiac arrest 7. Early death and the most severe motor impairment as cerebral palsy were seen in association with basal ganglia injuries 23. Predicting outcome in children with hypoxic ischemic. Predicting outcome in adults with status epilepticus. Predicting outcome from hypoxiclschemic coma article pdf available in jama the journal of the american medical association 25310. Anoxichypoxic brain injury abi results from reduced. Prognosis of anoxicischemic encephalopathy palliative. Fred plum, md outcome from coma caused by cerebral hypoxiaischemia eg, cardiac arrest was compared with serial neurological findings in 210 patients.
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. Full text is available as a scanned copy of the original print version. Abdullah presents a patient in a comatose state as the result of a cardiac arrest, one cause of hypoxicischemic coma, a condition with many etiologies, all of which lead to brain tissue damage from lack of oxygen. Involvement of the posterior limb of the internal capsule plic was found to be associated with abnormal motor outcome, 23.
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 most characteristic example of hypoxic ischemic brain damage is produced by cardiac arrest. Clinical assessment of patients with hibi is difficult 10 and often depends on the support of ancillary investigations to guide prognosis and management. Pdf outcome from coma caused by cerebral hypoxiaischemia eg, cardiac arrest was compared with serial neurological findings in 210 patients find. How to assess prognosis after cardiac arrest and therapeutic. Jun 17, 2015 the spectrum of disability resulting from hypoxic ischemic encephalopathy ranges from complete recovery to coma or even death 3, 4. A hypoxic brain injury is a type of brain injury that occurs when there is a disruption in. Predicting neurological outcome after cardiac arrest. Predicting outcomes after neonatal hypoxicischemic injury. Predicting outcome from hypoxicischemic coma pubmed. 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. Request pdf predicting outcome in children with hypoxic ischemic encephalopathy hypoxic ischemic encephalopathy hie is common in children, and providing accurate and timely prognostic. Does hypothermia influence the predictive value of bilateral absent n20 after cardiac arrest.
A new multimodal approach to prognostication is therefore required, which may. Predicting clinical outcome in comatose cardiac arrest patients. However, during the period of the study, it was the conventional wisdom that certain clinical features eg, unreactive pupils predicated poor recovery. Backgroundprognostication following hypoxic ischemic encephalopathy brain injury is important for clinical management. Predicting the outcome from hypoxicischemic coma jama. Neurodevelopmental effect of intracranial hemorrhage. Hypoxicischaemic brain injury hibi is the main cause of death in patients who are comatose after resuscitation from cardiac arrest.
A prospective analysis of 40 patients with hypoxicischemic coma lasting at least 6 h following sudden cardiac arrest was undertaken. A prospective clinical and electrophysiological study. Introduction and context cardiac arrest results in the cessation of spontaneous circulation, which causes hypoxic ischemic encephalopathy, the severity of which is primarily related to the. Cerebral resuscitation study group of the belgian society for intensive care. Prognostication after cardiac arrest critical care full text. Predicting the outcome from hypoxicischemic coma predicting to the editor. Although we present a heterogeneous population it is an accurate reflection of clinical practice. A literature search of medline was performed using the search terms hie and. 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 hypoxic ischemic encephalopathy hie. To examine whether the severity and spatial distribution of reductions in apparent diffusion coefficient adc are associated with clinical outcomes in patients who become comatose after cardiac arrest. A prospective analysis of 40 patients with hypoxic ischemic coma lasting at least 6 h following sudden cardiac arrest was undertaken. Outcome from coma caused by cerebral hypoxiaischemia eg, cardiac. Clinical trials showed that 27% of posthypoxic coma patients regained. Diffusion mri may help predicting longterm neurological sequelae of hypoxicischemic encephalopathy.
Central gray matter damage, the hallmark of term acute perinatal hypoxiaischemia, frequently leads to severe cerebral palsy and sometimes death. Predicting outcome from hypoxiclschemic coma jama network. Clinical assessment is difficult and so often these days compromised by sedation. The most characteristic example of hypoxicischemic brain damage is produced by cardiac arrest. Levy and colleagues 1 provide very helpful information about the prognosis of hypoxicischemic coma.
Predicting motor outcome and death in term hypoxic. Rehabilitation indexeri, glasgow coma scalegcs, coma remission scale crs. Jul 18, 2018 amplitudeintegrated eeg is useful in predicting neurodevelopmental outcome in fullterm infants with hypoxic ischemic encephalopathy. Predicting outcome from hypoxicischemic coma jama jama. Prediction of awakening after outofhospital cardiac arrest. Sep and eeg findings did not distinguish between these outcomes.
Exploratory use of decision tree analysis in classification. Get a printable copy pdf file of the complete article 453k, or click on a page image below to browse page by page. Predicting outcome in children with hypoxic ischemic encephalopathy article in pediatric critical care medicine 91. Robinson, university of washington, seattle, wa, usa. Clinical trials showed that 27% of post hypoxic coma patients regained consciousness within 28 days, 9% remained comatose or in an unresponsive wakefulness syndrome uws, and 64% died 3, 4. The journal of the american medical association 1985 september 6. Summary awakening from postanoxic coma is increasingly observed, despite early absence of motor signs and frank elevation of serum markers of brain injury. Predicting outcome from hypoxicischemic coma david e. Coma following a hypoxic ischemic event is a serious condition and common reason for admission to the pediatric intensive care unit. Therefore, dwi can be used to predict the outcomes of hibi. Predictive value of glasgow coma score for awakening after outofhospital cardiac arrest.
We evaluate clinical model and then the added value of mri data. Prognosis of anoxicischemic encephalopathy palliative care. Links to pubmed are also available for selected references. Introduction and context cardiac arrest results in the cessation of spontaneous circulation, which causes hypoxicischemic encephalopathy, the severity of which is primarily related to the.
The absence of somatosensoryevoked potentials performed early after onset of hypoxicischemic coma has a high specificity for predicting the likelihood of nonawakening. Predicting motor outcome and death in term hypoxicischemic. Tools for predicting bad outcome included repeated neurological examination persisting sarnat stage 3 or duration of coma 2448 h, persistence of abnormal brainstem reflexes 2448 h, severely abnormal eeg lowamplitude activity, alphacoma, areactive delta or thetacoma, burstsuppression activity, isoelectricity or uninterrupted. If patients with a preconceived poor prognosis received less than maximal sustained supportive care, the outcome may have been influenced by these preconceptions. Quantitative analysis of the loss of distinction between gray. 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. We evaluated the accuracy of early brain mri for predicting death, the presence and severity of motor impairment, and ability to. 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. Although some suggest that a glasgow coma scale gcs score outcome, 3,4 others have demonstrated that gcs at admission was a poor predictor. Incidence and prediction of outcome in hypoxicischemic. Cardiac arrest causes the cessation of cerebral blood flow, which produces loss of.
Prognostication after cardiac arrest critical care. Hypoxicischaemic brain injury is common and usually due to cardiac arrest or profound hypotension. Prediction of poor outcome after hypoxicischemic brain. In patients with postcardiac arrest coma, 4 clinical signs absent corneal and pupilary reflexes, absent motor response, and absent withdrawal to pain assessed 24 hours after cardiac arrest as well as absent motor response assessed 72 hours after the cardiac arrest are precise and accurate for predicting a. Although some suggest that a glasgow coma scale gcs score jan 14, 2014. Hypoxic ischemic injury in adult patients post cardiac. Most models predicting outcome of hypoxic ischemic coma have been developed using regression methodology.
Neurodevelopmental effect of intracranial hemorrhage observed. Early death and the most severe motor impairment as cerebral palsy were. Frontiers exploratory use of decision tree analysis in. Predicting the neurologic outcome of a child who has sustained a severe hypoxic ischemic event is crucial for several reasons. Prognosis and therapy after cardiac arrestinduced coma.
Hypoxic ischemic encephalopathy hie is common in children, and providing accurate and timely prognostic information is important in determining the appropriate level of care. 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. Predicting the neurological outcome in cardiac arrest survivors is of increasing importance to critical care teams and family members. Diffusionweighted imaging dwi can detect acute and subacute brain abnormalities following global cerebral hypoxia.
Mar 08, 1985 predicting outcome from hypoxic ischemic coma. Attempts to prognosticate outcome accurately after cardiac arrest have generated abundant research. Accurate prediction of the neurological outcome following hypoxicischemic brain injury hibi remains difficult. A prospective clinical and electrophysiologic study. This fast fact discusses prognostic factors in adults with aie after cardiac arrest.
Outcome from coma caused by cerebral hypoxiaischemia eg, cardiac arrest was compared with serial neurological findings in 210 patients. Because coma has a high rate of mortality and morbidity in children, and the clinician may be unsure of the outcome very early in the course, it is important to have strategies to define prognosis. Levy and his team analyzed 210 comatose patients after hypoxicischemic events, performing neurologic exams within the first day and then at intervals up to 14 days after coma onset. We are aware of one model incorporating electrophysiological variables rather than mr imaging developed using classification and regression tree analysis cart 8. Crs may be of some value to predict outcome of inpatient. Predicting clinical outcome in comatose cardiac arrest. Predicting clinical outcome in comatose cardiac arrest patients using early. A prognostication worksheet will be completed and left in the chart by the postanoxic coma neurophysiology consult pcnc service service after completing the day 3 exam, or after ceeg and ssep assessments are completed.
Coma following a hypoxicischemic event is a serious condition and common reason for admission to the pediatric intensive care unit. To this end, we searched the pubmed, embase, and cochrane library databases for studies that examine. Fred plum, md outcome from coma caused by cerebral hypoxiaischemia eg, cardiac arrest was compared with serial neurological findings in. Conclusion the absence of somatosensoryevoked potentials performed early after onset of hypoxicischemic coma has a high specificity for predicting the likelihood of nonawakening. Hypoxicischemic encephalopathy clinical presentation. Predicting outcome from hypoxic ischemic coma david e.
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