Edgren E, Hedstrand U, Kelsey S, Sutton-Tyrrell K, Safar P
Department of Anaesthesiology and Intensive Care, University Hospital, Uppsala, Sweden.
Lancet. 1994 Apr 30;343(8905):1055-9. doi: 10.1016/s0140-6736(94)90179-1.
When a patient resuscitated from cardiac arrest remains unconscious the clinician would like to have a reliable early method for predicting the outcome. The objective of our study was to predict cerebral outcome after cardiac arrest by clinical neurological examination. The data were drawn from an international multicentre controlled clinical trial of thiopentone. Twelve hospitals in nine countries took part. 262 comatose cardiac arrest survivors were followed up for one year. These patients were given advanced life support (American Heart Association guidelines) followed by intensive care to a standardised protocol. Glasgow and Glasgow-Pittsburgh coma scores and their constituent signs were recorded at fixed times. Outcome was taken to be the best cerebral performance at any time during follow-up, and for that purpose we used cerebral performance categories (CPC 1-5) of the Glasgow outcome categories. A poor outcome (CPC 3-5) could be predicted immediately after reperfusion (at entry into the study) with an accuracy ranging from 52% to 84% for various signs and scores. On the third day it was possible to identify severely disabled or permanently comatose survivors without false predictions using both coma scores and several of their constituent variables. The best predictor was absence of motor response to pain. This modelling exercise now needs to be repeated on a new series of patients but the results do suggest that, after 3 days, stringent ethical criteria can be met and used in decision-making about termination of care in comatose cardiac arrest survivors.
当一名从心脏骤停中复苏的患者仍处于昏迷状态时，临床医生希望有一种可靠的早期方法来预测其预后。我们研究的目的是通过临床神经学检查来预测心脏骤停后的脑功能预后。数据取自一项关于硫喷妥钠的国际多中心对照临床试验。九个国家的12家医院参与了该试验。对262名昏迷的心脏骤停幸存者进行了为期一年的随访。这些患者接受了高级生命支持（遵循美国心脏协会指南），随后按照标准化方案进行重症监护。在固定时间记录格拉斯哥昏迷评分和格拉斯哥 - 匹兹堡昏迷评分及其组成体征。预后被定义为随访期间任何时间的最佳脑功能表现，为此我们使用了格拉斯哥预后分类中的脑功能表现类别（CPC 1 - 5）。对于各种体征和评分，在再灌注后（进入研究时）即可预测不良预后（CPC 3 - 5），准确率在52%至84%之间。在第三天，使用昏迷评分及其几个组成变量可以准确识别出严重残疾或永久性昏迷的幸存者，且无假阳性预测。最佳预测指标是对疼痛无运动反应。现在需要在新的一系列患者中重复这个建模过程，但结果确实表明，在3天后，可以满足严格的伦理标准，并将其用于昏迷心脏骤停幸存者护理终止的决策制定。
