Introduction

This chapter addresses the following issues concerning cardiopulmonary arrest (CA): (i) prognosis, (ii) clinical syndromes of brain injury, and (iii) clinical and laboratory predictors of outcome. The accurate prognosis and chance for good neurologic recovery is of obvious interest to family members of patients with anoxic coma. In addition, accurate prediction of poor outcome (e.g., mortality or persistent vegetative state) provides important information to intensive care unit teams, so that they are able to provide appropriate support to family members who may be involved in decisions for patients who do not have advanced directives.

The magnitude of out-of-hospital CA is uncertain, with estimates between 200,000 and 500,000 cases annually in the United States (1,2). In one study, the incidence was 7 times higher in subjects with clinically recognized heart disease (5.98/1000 vs. 0.82/1000 subject-years) and was the highest in the subgroup of patients with congestive heart failure (21.9/1000 subject-years) (3). The overall prognosis for anoxic coma is poor, with 85% or more having a poor outcome (death or a vegetative state) within a month of the initial insult (4,5).

Two recent clinical trials of hypothermia in CA-targeted patients who were felt to be at high risk for mortality and severe brain injury. Inclusion criteria were CA due to ventricular fibrillation, with persistent coma after restoration of spontaneous circulation (6,7). Examination of the normothermic control patients provides some idea of the prognosis of anoxic coma in patients receiving optimal resuscitation and intensive care treatment. In one, outcomes measured at hospital discharge among the 34 normothermic patients were as follows: 7 with normal or minimal disability, 2 with moderate disability (discharged to a rehabilitation service), 2 with severe disability (discharged to a long-term nursing facility), and 23 deaths (7). Overall, poor outcome was seen in 74%. In the European study, the outcome assessed at 6 months among 138 normothermic patients was favorable in 39%, but with a 55% mortality rate (6).

Your Heart and Nutrition

Your Heart and Nutrition

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