Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Curr Opin Crit Care. 2018 Jun;24(3):158-164. doi: 10.1097/MCC.0000000000000500.
Predicting neurological recovery in patients who are comatose after cardiac arrest is an important activity during postarrest care, and this prediction can affect survival. As no early test or clinical finding perfectly predicts potential for recovery, guidelines recommend using data from multiple examinations or tests to estimate patient prognosis.
Studies reported accuracy of initial clinical examination, progression of clinical examination, early (<24 h) brain imaging, electroencephalography (EEG), evoked potentials, later (>24 h) brain imaging, blood markers of brain injury, and cerebral oximetry for predicting good or poor outcome. In multiple cohorts, patients with status myoclonus with particular clinical or EEG features have potential for good outcome. When multiple tests were compared, each test provided independent information.
Absence of cortical functional recovery over time is detected using multiple testing modalities and remains strongly associated with poor outcome. Early recovery of cortical function increases the probability of good outcome. Concordant assessments from multiple tests increase confidence in prognostication.
预测心搏骤停后昏迷患者的神经恢复是复苏后护理的一项重要活动，这一预测结果可能会影响患者的存活。由于没有任何早期检查或临床发现能够完美预测恢复的可能性，因此指南建议使用多项检查或测试的数据来估计患者的预后。
研究报告了初始临床检查、临床检查进展、早期（<24 小时）脑影像学、脑电图（EEG）、诱发电位、晚期（>24 小时）脑影像学、脑损伤的血液标志物和脑氧饱和度对预测良好或不良预后的准确性。在多个队列中，具有特定临床或 EEG 特征的肌阵挛状态患者具有良好预后的潜力。当比较多项检查时，每项检查都提供了独立的信息。
使用多种测试模式检测到皮质功能随时间的恢复缺失仍然与不良预后密切相关。皮质功能的早期恢复增加了良好预后的可能性。来自多项测试的一致评估增加了预后预测的可信度。
