Zandbergen Eveline G J, de Haan Rob J, Reitsma Johannes B, Hijdra Albert
Department of Neurology and Clinical Neurophysiology, Academic Medical Center/University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
Intensive Care Med. 2003 Nov;29(11):1911-5. doi: 10.1007/s00134-003-1951-4. Epub 2003 Oct 2.
In patients who remain unconscious after cardiopulmonary resuscitation (CPR) poor outcome may be predicted with several tests. To use these tests, knowledge of a priori chances of poor outcome after varying periods of unconsciousness is needed. This study is aimed at providing such data.
Data regarding survival and recovery of consciousness were extracted from registry-based and prospective cohort studies of patients with anoxic-ischemic coma. A survival analysis was done using Kaplan-Meier estimates and 28-day outcomes were calculated for all patients unconscious after 24 h and 72 h, and 5 days, 7 days and 14 days after CPR. Patient characteristics and outcomes in our cohort were compared with those of published patient series.
After 28 days, 27% of 172 patients from the two cohort studies were alive and conscious, 9% were still unconscious, and 64% had died. The proportion of patients who regained consciousness decreased from 34% of those unconscious within the first 6 h post-CPR to 13% of those still unconscious after 2 weeks. The proportion surviving in an unconscious state increased from 6% of patients who were unconscious initially to 33% of those still unconscious after 2 weeks. The chance of survival remained unchanged up to 7 days after CPR, irrespective of the duration of unconsciousness. Patient characteristics and outcomes in our cohort were comparable to data available from the literature.
The a priori chances of (poor) outcome vary with the duration of unconsciousness after CPR. This study provides data for different time-intervals after CPR.
对于心肺复苏（CPR）后仍未苏醒的患者，可通过多种检查预测不良预后。要使用这些检查，需要了解不同昏迷时长后出现不良预后的先验概率。本研究旨在提供此类数据。
从基于登记的缺氧缺血性昏迷患者前瞻性队列研究中提取有关生存和意识恢复的数据。采用Kaplan-Meier估计法进行生存分析，并计算所有在CPR后24小时、72小时以及5天、7天和14天仍未苏醒患者的28天预后情况，并将我们队列中的患者特征及预后情况与已发表的患者系列数据进行比较。
28天后，两项队列研究中的172例患者中，27%存活且苏醒，9%仍未苏醒，64%已死亡。意识恢复患者的比例从CPR后最初6小时内未苏醒患者的34%降至2周后仍未苏醒患者的13%。处于昏迷状态存活的患者比例从最初昏迷患者的6%增至2周后仍未苏醒患者的33%。CPR后7天内的存活几率保持不变，与昏迷时长无关。我们队列中的患者特征及预后情况与文献中的现有数据相当。
（不良）预后的先验概率随CPR后昏迷时长而变化。本研究提供了CPR后不同时间间隔的数据。
