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Prognosticarion after cardiac arrest

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23 papers 0 to 25 followers
By Eduardo Roque Cardiologista com foco em cardiologia hospitalar e cuidados intensivos. Professor de clínica médica.
E O Jøogensen, A Malchow-Møller
The monitoring and predictive value of the electroencephalography (EEG) and neurological signs was evaluated in 125 patients who had sustained critical brain ischaemia during circulatory arrest of primary cardiovascular aetiology. Cranial nerve areflexia with mydriasis or extension of the upper limb in response to cutaneous stimulation reliably indicated brain death and appearance of the flexion reflex or of intermittent spikes and sharp waves in the EEG predicted an unfavourable outcome; but other EEG configurations and nuerological signs per se were inaccurate variables to assess the outcome...
June 1981: Resuscitation
Ravi G Gupta, Sarah M Hartigan, Markos G Kashiouris, Curtis N Sessler, Gonzalo M L Bearman
Severe sepsis and septic shock are among the leading causes of mortality in the intensive care unit. Over a decade ago, early goal-directed therapy (EGDT) emerged as a novel approach for reducing sepsis mortality and was incorporated into guidelines published by the international Surviving Sepsis Campaign. In addition to requiring early detection of sepsis and prompt initiation of antibiotics, the EGDT protocol requires invasive patient monitoring to guide resuscitation with intravenous fluids, vasopressors, red cell transfusions, and inotropes...
August 28, 2015: Critical Care: the Official Journal of the Critical Care Forum
Claudio Sandroni, Alain Cariou, Fabio Cavallaro, Tobias Cronberg, Hans Friberg, Cornelia Hoedemaekers, Janneke Horn, Jerry P Nolan, Andrea O Rossetti, Jasmeet Soar
OBJECTIVES: To review and update the evidence on predictors of poor outcome (death, persistent vegetative state or severe neurological disability) in adult comatose survivors of cardiac arrest, either treated or not treated with controlled temperature, to identify knowledge gaps and to suggest a reliable prognostication strategy. METHODS: GRADE-based systematic review followed by expert consensus achieved using Web-based Delphi methodology, conference calls and face-to-face meetings...
December 2014: Intensive Care Medicine
Christoph Selig, Christian Riegger, Burkhard Dirks, Michael Pawlik, Timo Seyfried, Werner Klingler
INTRODUCTION: Predicting the neurological outcome after cardiopulmonary resuscitation (CPR) is extremely difficult. We tested the hypothesis whether monitoring of bispectral index (BIS) and suppression ratio (SR) could serve as an early prognostic indicator of neurological outcomes after CPR. METHODS: Cerebral monitoring (BIS, SR) was started as soon as possible after initiation of CPR and was continued for up to 72h. The functional neurological outcome was measured on day 3, day 7 and again one month after CPR via a clinical examination and assessment according to the cerebral performance category score (CPC)...
February 2014: Resuscitation
Gustavo Saposnik, Amy K Guzik, Mathew Reeves, Bruce Ovbiagele, S Claiborne Johnston
OBJECTIVES: Age and stroke severity are major determinants of stroke outcomes, but systematically incorporating these prognosticators in the routine practice of acute ischemic stroke can be challenging. We evaluated the effect of an index combining age and stroke severity on response to IV tissue plasminogen activator (tPA) among patients in the National Institute of Neurological Disorders and Stroke (NINDS) tPA stroke trials. METHODS: We created the Stroke Prognostication using Age and NIH Stroke Scale (SPAN) index by combining age in years plus NIH Stroke Scale (NIHSS) ≥100...
January 1, 2013: Neurology
Tarek Sharshar, Giuseppe Citerio, Peter J D Andrews, Arturo Chieregato, Nicola Latronico, David K Menon, Louis Puybasset, Claudio Sandroni, Robert D Stevens
OBJECTIVE: Many patients admitted to the intensive care unit (ICU) have pre-existing or acquired neurological disorders which significantly affect their short-term and long-term outcomes. The ESICM Neuro Intensive Care Section convened an expert panel to establish a pragmatic approach to neurological examination (NE) of the critically ill patient. METHODS: The group conducted a comprehensive review of published studies on the NE of patients with coma, delirium, seizures and neuromuscular weakness in critically ill patients...
April 2014: Intensive Care Medicine
Pascal Stammet, Olivier Collignon, Christian Hassager, Matthew P Wise, Jan Hovdenes, Anders Åneman, Janneke Horn, Yvan Devaux, David Erlinge, Jesper Kjaergaard, Yvan Gasche, Michael Wanscher, Tobias Cronberg, Hans Friberg, Jørn Wetterslev, Tommaso Pellis, Michael Kuiper, Georges Gilson, Niklas Nielsen
BACKGROUND: Neuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurological outcome after cardiac arrest, but the relevance of recommended cutoff values has been questioned due to the lack of a standardized methodology and uncertainties over the influence of temperature management. OBJECTIVES: This study investigated the role of NSE as a prognostic marker of outcome after out-of-hospital cardiac arrest (OHCA) in a contemporary setting...
May 19, 2015: Journal of the American College of Cardiology
Sang Hoon Oh, Kyu Nam Park, Young-Min Shon, Young-Min Kim, Han Joon Kim, Chun Song Youn, Soo Hyun Kim, Seung Pill Choi, Seok Chan Kim
BACKGROUND: Modern treatments have improved the survival rate following cardiac arrest, but prognostication remains a challenge. We examined the prognostic value of continuous electroencephalography according to time by performing amplitude-integrated electroencephalography on patients with cardiac arrest receiving therapeutic hypothermia. METHODS AND RESULTS: We prospectively studied 130 comatose patients treated with hypothermia from September 2010 to April 2013...
September 22, 2015: Circulation
Tobias Cronberg, Janneke Horn, Michael A Kuiper, Hans Friberg, Niklas Nielsen
Brain injury is the dominant cause of death for cardiac arrest patients who are admitted to an intensive care unit, and the majority of patients die after withdrawal of life sustaining therapy (WLST) based on a presumed poor neurologic outcome. Mild induced hypothermia was found to decrease the reliability of several methods for neurological prognostication. Algorithms for prediction of outcome, that were developed before the introduction of mild hypothermia after cardiac arrest, may have affected the results of studies with hypothermia-treated patients...
June 10, 2013: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Romergryko G Geocadin, Scott M Eleff
PURPOSE OF REVIEW: Persistent coma after cardiac arrest is a source of great emotional and financial cost to grieving family members in particular and the healthcare system in general. Neurologic prognostication helps guide appropriate discussions between family members and healthcare providers. Recent advances in therapeutic care increase the challenges, both medical and financial, on local practitioners. RECENT FINDINGS: Evidence-based reviews by prestigious associations add additional support and guidance to the practitioner who must guide family members in this very difficult decision process...
June 2008: Current Opinion in Critical Care
Marion Leary, David A Fried, David F Gaieski, Raina M Merchant, Barry D Fuchs, Daniel M Kolansky, Dana P Edelson, Benjamin S Abella
OBJECTIVE: While the use of therapeutic hypothermia (TH) has improved outcomes after resuscitation from cardiac arrest, prognostication of survival and neurologic function remains difficult during the post-arrest time period. Bispectral index (BIS) monitoring, a non-invasive measurement of simplified electroencephalographic data, is increasingly being considered for post-arrest neurologic assessment and outcomes prediction, although data supporting the technique are limited. We hypothesized that BIS values within 24 h after resuscitation would correlate with neurologic outcomes at discharge...
September 2010: Resuscitation
Wei Xiong, Xiaofeng Jia
No abstract text is available yet for this article.
December 2014: Critical Care Medicine
P D Schellinger, R N Bryan, L R Caplan, J A Detre, R R Edelman, C Jaigobin, C S Kidwell, J P Mohr, M Sloan, A G Sorensen, S Warach
OBJECTIVE: To assess the evidence for the use of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) in the diagnosis of patients with acute ischemic stroke. METHODS: We systematically analyzed the literature from 1966 to January 2008 to address the diagnostic and prognostic value of DWI and PWI. RESULTS AND RECOMMENDATIONS: DWI is established as useful and should be considered more useful than noncontrast CT for the diagnosis of acute ischemic stroke within 12 hours of symptom onset...
July 13, 2010: Neurology
Irina Dragancea, Janneke Horn, Michael Kuiper, Hans Friberg, Susann Ullén, Jørn Wetterslev, Jules Cranshaw, Christian Hassager, Niklas Nielsen, Tobias Cronberg
BACKGROUND: The reliability of some methods of neurological prognostication after out-of-hospital cardiac arrest has been questioned since the introduction of induced hypothermia. The aim of this study was to determine whether different treatment temperatures after resuscitation affected the prognostic accuracy of clinical neurological findings and somatosensory evoked potentials (SSEP) in comatose patients. METHODS: We calculated sensitivity and false positive rate for Glasgow Coma Scale motor score (GCS M), pupillary and corneal reflexes and SSEP to predict poor neurological outcome using prospective data from the Target Temperature Management after Out-of-Hospital Cardiac Arrest Trial which randomised 939 comatose survivors to treatment at either 33 °C or 36 °C...
August 2015: Resuscitation
Nicholas A Blondin, David M Greer
BACKGROUND: Therapeutic hypothermia is now commonly used to improve neurologic outcomes in eligible patients after cardiac arrest. The physiologic effects of cooling and pharmacologic effects of sedatives and neuromuscular blocking agents can affect the clinical exam and neurophysiologic findings. This can lead to uncertainty in neurologic prognostication. In this article, we review data on assessing prognosis in patients treated with therapeutic hypothermia. REVIEW SUMMARY: Features of the clinical examination, neurophysiologic testing (including somatosensory-evoked potentials and electroencephalography), serum/cerebrospinal fluid biomarkers and neuroimaging can be used to help predict prognosis...
September 2011: Neurologist
Erik Westhall, Ingmar Rosén, Andrea O Rossetti, Anne-Fleur van Rootselaar, Troels Wesenberg Kjaer, Janneke Horn, Susann Ullén, Hans Friberg, Niklas Nielsen, Tobias Cronberg
BACKGROUND: Electroencephalography (EEG) is widely used to assess neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by inter-rater variability. The American Clinical Neurophysiology Society (ACNS) has recently proposed a standardized EEG-terminology for critical care to address these limitations. METHODS/DESIGN: In the TTM-trial, 399 post cardiac arrest patients who remained comatose after rewarming underwent a routine EEG...
August 16, 2014: BMC Neurology
E F M Wijdicks, A Hijdra, G B Young, C L Bassetti, S Wiebe
OBJECTIVE: To systematically review outcomes in comatose survivors after cardiac arrest and cardiopulmonary resuscitation (CPR). METHODS: The authors analyzed studies (1966 to 2006) that explored predictors of death or unconsciousness after 1 month or unconsciousness or severe disability after 6 months. RESULTS: The authors identified four class I studies, three class II studies, and five class III studies on clinical findings and circumstances...
July 25, 2006: Neurology
Claudio Sandroni, Romergryko G Geocadin
PURPOSE OF REVIEW: Prediction of neurological prognosis in patients who are comatose after successful resuscitation from cardiac arrest remains difficult. Previous guidelines recommended ocular reflexes, somatosensory evoked potentials and serum biomarkers for predicting poor outcome within 72  h from cardiac arrest. However, these guidelines were based on patients not treated with targeted temperature management and did not appropriately address important biases in literature. RECENT FINDINGS: Recent evidence reviews detected important limitations in prognostication studies, such as low precision and, most importantly, lack of blinding, which may have caused a self-fulfilling prophecy and overestimated the specificity of index tests...
June 2015: Current Opinion in Critical Care
Noritoshi Ito, Kei Nishiyama, Clifton W Callaway, Tomohiko Orita, Kei Hayashida, Hideki Arimoto, Mitsuru Abe, Tomoyuki Endo, Akira Murai, Ken Ishikura, Noriaki Yamada, Masahiro Mizobuchi, Hideki Anan, Kazuo Okuchi, Hideto Yasuda, Toshiaki Mochizuki, Yuka Tsujimura, Takeo Nakayama, Tetsuo Hatanaka, Ken Nagao
AIM: To investigate the association between regional brain oxygen saturation (rSO2) at hospital arrival and neurological outcomes at 90 days in patients with out-of-hospital cardiac arrest (OHCA). METHODS: The Japan-Prediction of neurological Outcomes in patients post cardiac arrest (J-POP) registry is a prospective, multicenter, cohort study to test whether rSO2 predicts neurological outcomes after OHCA. We measured rSO2 in OHCA patients immediately after hospital arrival using a near-infrared spectrometer placed on the forehead with non-blinded fashion...
June 2014: Resuscitation
David K Hahn, Romergryko G Geocadin, David M Greer
AIM: Neuroimaging has been proposed as a predictor of neurologic outcome in comatose survivors of cardiac arrest. We reviewed the quality and level of evidence of the current neuroimaging literature for predicting neurologic outcome in cardiac arrest patients treated with or without therapeutic hypothermia (TH). DATA SOURCES: Medline, EMBASE, and Cochrane Databases were searched using the terms "cardiac arrest," "cardiopulmonary resuscitation," "brain hypoxia," "brain anoxia," "brain hypoxia-ischaemia," "neuroimaging," and "prognosis...
February 2014: Resuscitation
2015-10-18 22:28:33
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