Department of Intensive Care Medicine, Neurology Service, Centre Hospitalier Universitaire Vaudois, University Hospital, Faculty of Biology and Medicine, Lausanne, Switzerland.
Curr Opin Crit Care. 2011 Jun;17(3):254-9. doi: 10.1097/MCC.0b013e328344f2ae.
Therapeutic hypothermia and aggressive management of postresuscitation disease considerably improved outcome after adult cardiac arrest over the past decade. However, therapeutic hypothermia alters prognostic accuracy. Parameters for outcome prediction, validated by the American Academy of Neurology before the introduction of therapeutic hypothermia, need further update.
Therapeutic hypothermia delays the recovery of motor responses and may render clinical evaluation unreliable. Additional modalities are required to predict prognosis after cardiac arrest and therapeutic hypothermia. Electroencephalography (EEG) can be performed during therapeutic hypothermia or shortly thereafter; continuous/reactive EEG background strongly predicts good recovery from cardiac arrest. On the contrary, unreactive/spontaneous burst-suppression EEG pattern, together with absent N20 on somatosensory evoked potentials (SSEP), is almost 100% predictive of irreversible coma. Therapeutic hypothermia alters the predictive value of serum markers of brain injury [neuron-specific enolase (NSE), S-100B]. Good recovery can occur despite NSE levels >33 μg/l, thus this cut-off value should not be used to guide therapy. Diffusion MRI may help predicting long-term neurological sequelae of hypoxic-ischemic encephalopathy.
Awakening from postanoxic coma is increasingly observed, despite early absence of motor signs and frank elevation of serum markers of brain injury. A new multimodal approach to prognostication is therefore required, which may particularly improve early prediction of favorable clinical evolution after cardiac arrest.
在过去的十年中，治疗性低温和复苏后疾病的积极治疗极大地改善了成年人心搏骤停患者的预后。然而，治疗性低温改变了预后准确性。在引入治疗性低温之前，经美国神经病学学会验证的预后预测参数需要进一步更新。
治疗性低温延迟了运动反应的恢复，可能使临床评估变得不可靠。需要额外的方法来预测心搏骤停和治疗性低温后的预后。脑电图（EEG）可以在治疗性低温期间或之后进行；持续/反应性 EEG 背景强烈预测心搏骤停后的良好恢复。相反，无反应/自发爆发抑制 EEG 模式，加上体感诱发电位（SSEP）上无 N20，几乎 100%预测不可逆昏迷。治疗性低温改变了脑损伤血清标志物[神经元特异性烯醇化酶（NSE）、S-100B]的预测价值。尽管 NSE 水平>33μg/l，仍可能出现良好恢复，因此不应使用该截断值来指导治疗。弥散 MRI 可能有助于预测缺氧缺血性脑病的长期神经后遗症。
尽管早期缺乏运动迹象和明显的脑损伤血清标志物升高，但越来越多的患者从缺氧缺血性昏迷中苏醒。因此，需要一种新的多模态预测方法，这可能特别有助于早期预测心搏骤停后的有利临床演变。
