Rothstein Ted L
Department of Neurology, George Washington University, Washington DC, USA.
Clin Neurol Neurosurg. 2014 Nov;126:205-9. doi: 10.1016/j.clineuro.2014.08.031. Epub 2014 Sep 3.
Rational medical management of patients who remain comatose following cardio-pulmonary resuscitation (CPR) due to anoxic-ischemic encephalopathy depends upon the early identification of those with a hopeless prognosis - regardless of how aggressively they are managed. Conversely, it is mandatory that we recognize those patients with the potential to recover in order to institute aggressive therapeutic measures. The bilateral absence of the N20 Cortical Somatosensory Evoked Potential has been identified as the most reliable predictor of an unfavorable prognosis in normothermic patients. Two randomized trials have determined that mild therapeutic hypothermia (TH) delivered immediately after CPR improves neurologic outcomes. TH has now become the standard of care in the management of patients with cardio-pulmonary arrest. Eight studies targeting patients who were comatose following CPR, treated with TH, and using SSEP as an outcome predictor are reviewed. There is only one patient treated with TH who appears to have fully recovered following cardiac arrest who was initially found to have bilateral absent cortical potentials. This opinion paper will address whether the criteria that placed reliance upon SSEP to predict unfavorable outcome in post cardio-pulmonary arrest patients after receiving TH, still apply.
对于因缺氧缺血性脑病而在心肺复苏（CPR）后仍处于昏迷状态的患者，合理的医疗管理取决于早期识别出预后无望的患者——无论对他们采取多么积极的治疗措施。相反，我们必须识别出有康复潜力的患者，以便采取积极的治疗措施。双侧N20皮质体感诱发电位缺失已被确定为体温正常患者预后不良最可靠的预测指标。两项随机试验已确定，心肺复苏后立即进行轻度治疗性低温（TH）可改善神经学预后。TH现已成为心肺骤停患者管理的护理标准。本文综述了八项针对心肺复苏后昏迷、接受TH治疗并将体感诱发电位（SSEP）作为预后预测指标的患者的研究。仅有一名接受TH治疗的患者在心脏骤停后似乎完全康复，该患者最初被发现双侧皮质电位缺失。本观点论文将探讨在接受TH治疗后，依赖SSEP预测心肺骤停后患者不良预后的标准是否仍然适用。
