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The Brain in Post-anoxic Coma: Predicting Outcome

  • G. B. Young
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine 2002 book series (YEARBOOK, volume 2002)

Abstract

About 40% of patients with cardiac arrest can be resuscitated with restoration of spontaneous circulation and respiration. The overall 1 year survival rate of initially unconscious survivors resuscitated from cardiac arrest has been variably quoted to be between 10 and 25% [1, 2]. Anoxic-ischemic encephalopathy is the principal cause of mortality in at least 30–40% of those who die; only 3–10% return to their previous lifestyle, including employment [3]. Under 1% survive in a persistent vegetative state (PVS) [4]. Since primary cardiac arrest is so common, the problems of assessment and management of anoxic-ischemic encephalopathy are of great importance to the intensivist and emergency physician.

Keywords

Status Epilepticus Epileptiform Activity Median Nerve Stimulation Primary Cardiac Arrest Generalize Convulsive Status Epilepticus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Thomassen A, Wernberg M (1979) Prevalence and prognostic significance of coma after cardiac arrest outside intensive care and coronary care units. Acta Anesth Scand 23:143–148CrossRefGoogle Scholar
  2. 2.
    Longstreth W, Diehr P, Inui TS (1983) Prediction of awakening after out-of-hospital cardiac arrest. N Engl J Med 308:1378–1382PubMedCrossRefGoogle Scholar
  3. 3.
    Edgren E, Hedstand U, Kelsey S, Sutton-Tyrell K, Safar P (1994) Assessment of neurological prognosis in comatose survivors of cardiac arrest. Lancet 343:1052–1053CrossRefGoogle Scholar
  4. 4.
    Stephenson HE, Reid CL, Hinton W (1952) Some common denominators in 1200 cases of cardiac arrest. Ann Surg 137:731–740CrossRefGoogle Scholar
  5. 5.
    Pearigen P, Gwinn R, Simon RP (1996) The effects of in vivo hypoxia on brain injury. Brain Res 725:184–191PubMedGoogle Scholar
  6. 6.
    Dawson VL, Dawson TM, Bartley DA, Uhl GR, Snyder SH (1993) Mechanisms of nitric oxide-mediated neurotoxicity in primary brain cultures. J Neurosci 13:2651–2661PubMedGoogle Scholar
  7. 7.
    Korein J, Maccario M (1969) On the diagnosis of cerebral death: a prospective study. Electroenceph Clin Neurophysiol 27:700PubMedGoogle Scholar
  8. 8.
    Bell JA, Hodgson HJF (1974) Coma after cardiac arrest. Brain 97:361–372PubMedCrossRefGoogle Scholar
  9. 9.
    Levy DE, Caronna JJ, Singer BH, et al (1985) Predicting outcome from hypoxic-ischemic coma. JAMA 253:1420–1426PubMedCrossRefGoogle Scholar
  10. 10.
    Bassetti C, Bomio F, Mathis J, Hess CW (1996) Early prognosis in coma after cardiac arrest: a prospective clinical electrophysiological, and biochemical study of 60 patients. J Neurol Neurosurg Psychiatry 61:610–615PubMedCrossRefGoogle Scholar
  11. 11.
    Saltman L, Marori M (1994) Coma after cardiac arrest: will he recover all right? Lancet 343:1052–1053CrossRefGoogle Scholar
  12. 12.
    Zandbergen ED, de Haan RJ, Stoutenbeek CP, et al (1998) Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet 352:1808–1812PubMedCrossRefGoogle Scholar
  13. 13.
    Connolly JF, Phillips NA, Stewart SH, Blake WG (1992) Event-related potential sensitivity to acoustic and semantic properties of terminal words in sentences. Brain Lang 43:1–18PubMedCrossRefGoogle Scholar
  14. 14.
    Kirino T (1982) Delayed neuronal death in the gerbil hippocampus following ischemia. Brain Res 239:57–69PubMedCrossRefGoogle Scholar
  15. 15.
    Young GB (2000) The EEG in coma. J Clin Neurophysiol 17:473–485PubMedCrossRefGoogle Scholar
  16. 16.
    Brierley JB, Adams JH, Graham DI, Simpson JA (1971) Neocortical death after cardiac arrest. Lancet ii:560–565Google Scholar
  17. 17.
    Brenner RP, Schwartzman RJ, Richey ET (1975) Prognostic significance of episodic low amplitude or relatively isoelectric EEG patterns. Dis Nerv Syst 36:582–589PubMedGoogle Scholar
  18. 18.
    Pampiglioni G, Harden A (1968) Resuscitation after cardiopulmonary arrest. Lancet 1:1261–1264CrossRefGoogle Scholar
  19. 19.
    Chen R, Bolton CF, Young GB (1996) Prediction of outcome in patients with anoxic coma: A clinical and electrophysiological study. Crit Care Med 24:672–678PubMedCrossRefGoogle Scholar
  20. 20.
    Synek VM (1988) Prognostically important coma patterns in diffuse anoxic and traumatic encephalopathies in adults. J Clin Neurophysiol 5:161–174PubMedCrossRefGoogle Scholar
  21. 21.
    Young GB, Kreeft JH, McLachlan RS, Demelo J (1999) EEG and clinical associations with mortality in comatose patients in a general intensive care unit. J Clin Neurophysiol 16:354–360PubMedCrossRefGoogle Scholar
  22. 22.
    Simon RP, Aminoff MJ (1986) Electrographic status epilepticus in fatal anoxic coma. Ann Neurol 20:351–355PubMedCrossRefGoogle Scholar
  23. 23.
    Mori E, Tsuruta H (1983) Transient eye opening with EEG burst-suppression pattern in postanoxic encephalopathy. Arch Neurol 40:189–190PubMedCrossRefGoogle Scholar
  24. 24.
    Treiman DM, Walton NY, Kendrick C (1990) A prospective sequence of electroencephalo-graphic changes during generalized convulsive status epilepticus. Epilepsy Res 5:49–60PubMedCrossRefGoogle Scholar
  25. 25.
    Hauser WA (1983) Status epilepticus: Frequency, etiology and neurological sequelae. In: Delgado-Escueta AV, Wasterlain CG, Treiman DM, Porter RJ (eds) Advances in Neurology Vol 34: Status Epilepticus: Mechanisms of Brain Damage and Treatment. Raven Press, New York, pp 3–14Google Scholar
  26. 26.
    Synek VM, Synek BJL (1984) “Theta pattern coma” a variant on alpha pattern coma. Clin EEG 15:116–121Google Scholar
  27. 27.
    Young GB, Blume WT, Campbell VC, et al. (1994) Alpha, alpha-theta and theta coma: a clinical outcome study utilizing serial recordings. Electroenceph Clin Neurophysiol 91:93–99PubMedCrossRefGoogle Scholar
  28. 28.
    Holmes GL, Lombroso CT (1993) Prognostic value of background patterns in neonatal EEG. J Clin Neurophysiol 10:323–352PubMedCrossRefGoogle Scholar
  29. 29.
    Younkin DP (1993) Magnetic resonance spectroscopy in hypoxic-ischemic encephalopathy. Clin Invest Med 16:116–121Google Scholar
  30. 30.
    Rothstein TL (2000) The role of evoked potentials in anoxic-ischemic coma and severe brain trauma. J Clin Neurophysiol 17:486–497PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2002

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  • G. B. Young

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