Blondin Nicholas A, Greer David M
Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA.
Neurologist. 2011 Sep;17(5):241-8. doi: 10.1097/NRL.0b013e318224ee0e.
Therapeutic hypothermia is now commonly used to improve neurologic outcomes in eligible patients after cardiac arrest. The physiologic effects of cooling and pharmacologic effects of sedatives and neuromuscular blocking agents can affect the clinical exam and neurophysiologic findings. This can lead to uncertainty in neurologic prognostication. In this article, we review data on assessing prognosis in patients treated with therapeutic hypothermia.
Features of the clinical examination, neurophysiologic testing (including somatosensory-evoked potentials and electroencephalography), serum/cerebrospinal fluid biomarkers and neuroimaging can be used to help predict prognosis. However, no single test can predict poor prognosis with absolute certainty. Given the features that help to predict poor, indeterminate, or good outcome, we provide practical advice in assessing neurologic prognosis after cardiac arrest in patients treated with therapeutic hypothermia.
The American Academy of Neurology practice parameters for assessing prognosis after cardiac arrest may not be accurate for patients treated with therapeutic hypothermia. Application of these guidelines may lead to overly pessimistic prognostication and premature withdrawal of care. If uncertainty exists regarding the prognosis in a given patient after cardiac arrest, additional time should be allowed to pass, as patients may ultimately recover with good neurologic outcome.
治疗性低温目前常用于改善心脏骤停后符合条件患者的神经学预后。降温的生理效应以及镇静剂和神经肌肉阻滞剂的药理效应会影响临床检查和神经生理学检查结果。这可能导致神经学预后判断的不确定性。在本文中，我们回顾了关于评估接受治疗性低温治疗患者预后的数据。
临床检查特征、神经生理学检测（包括体感诱发电位和脑电图）、血清/脑脊液生物标志物及神经影像学检查可用于帮助预测预后。然而，没有单一的检查能够绝对确定地预测不良预后。鉴于有助于预测不良、不确定或良好预后的特征，我们提供了评估接受治疗性低温治疗的心脏骤停患者神经学预后的实用建议。
美国神经病学学会关于评估心脏骤停后预后的实践参数对于接受治疗性低温治疗的患者可能不准确。应用这些指南可能导致过度悲观的预后判断和过早停止治疗。如果对于特定心脏骤停患者的预后存在不确定性，应给予更多时间，因为患者最终可能获得良好的神经学恢复。
