Taccone Fabio Silvio, Baar Ingrid, De Deyne Cathy, Druwe Patrick, Legros Benjamin, Meyfroidt Geert, Ossemann Michel, Gaspard Nicolas
Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.
Department of Neurology, Antwerp University Hospital, 2650, Edegem, Belgium.
Acta Neurol Belg. 2017 Mar;117(1):3-15. doi: 10.1007/s13760-017-0755-1. Epub 2017 Feb 6.
The prognosis of patients who are admitted to the hospital after cardiac arrest often relies on neurological examination, which could be significantly influenced by the use of sedative drugs or the implementation of targeted temperature management. The need for early and accurate prognostication is crucial as up to 15-20% of patients could be considered as having a poor outcome and may undergo withdrawal of life-sustaining therapies while a complete neurological recovery is still possible. As current practice in Belgium is still based on a very early assessment of neurological function in these patients, the Belgian Society of Intensive Care Medicine created a multidisciplinary Task Force to provide an optimal approach for monitoring and refine prognosis of CA survivors. This Task Force underlined the importance to use a multimodal approach using several additional tools (e.g., electrophysiological tests, neuroimaging, biomarkers) and to refer cases with uncertain prognosis to specialized centers to better evaluate the extent of brain injury in these patients.
心脏骤停后入院患者的预后通常依赖于神经学检查,而这可能会受到镇静药物的使用或目标温度管理实施的显著影响。早期准确预后的必要性至关重要,因为高达15%至20%的患者可能被视为预后不良,可能会在仍有可能实现完全神经功能恢复的情况下接受生命维持治疗的撤减。由于比利时目前的做法仍基于对这些患者神经功能的非常早期评估,比利时重症医学学会成立了一个多学科特别工作组,以提供监测和完善心脏骤停幸存者预后的最佳方法。该特别工作组强调了使用多模式方法(使用几种额外工具,如电生理测试、神经成像、生物标志物)以及将预后不确定的病例转诊至专业中心以更好评估这些患者脑损伤程度的重要性。