View Entire Collection
By Clinical Topic
Diabetes – Summer 2012
Future of Nursing Initiative
Heart Failure - Fall 2011
Influenza - Winter 2011
Nursing Ethics - Fall 2011
Trauma - Fall 2010
Traumatic Brain Injury - Fall 2010
Fluids & Electrolytes
WEDNESDAY, Feb. 29 (HealthDay News) -- Although neurological tests are highly reliable predictors of death in patients who remain in a coma following cardiopulmonary resuscitation (CPR), withdrawal-of-treatment decisions may need to be delayed for those who undergo mild hypothermia therapy, according to a Dutch study published in the February issue of the Annals of Neurology.
Aline Bouwes, M.D., of the Academic Medical Center in Amsterdam, and associates conducted a prospective study of 391 adult comatose patients given CPR prior to treatment with hypothermia (32 to 34 degrees Celsius) in the intensive care units of 10 Dutch medical centers, to determine the reliability of neurologic examination, neuron-specific enolase (NSE), and median nerve somatosensory-evoked potentials (SEPs) in predicting poor outcomes.
The researchers observed poor outcomes (death) in 208 patients (53 percent), with reliable predictors being absent papillary light responses (false-positive rate [FPR] 1) or absent corneal reflexes 72 hours after CPR (FPR 4), and absent SEPs during hypothermia (FPR 3) and after rewarming (FPR 0). Data showed that NSE levels and motor scores 72 hours after CPR (FPR 10) were not good predictors.
"In patients with persisting coma after CPR and therapeutic hypothermia, use of motor score or NSE, as recommended in current guidelines, could possibly lead to inappropriate withdrawal of treatment," the authors write. "Poor outcomes can reliably be predicted by testing brainstem reflexes 72 hours after CPR and performing SEPs."
One author disclosed financial ties to the Schering-Plough Research Institute.
Full Text (subscription or payment may be required)
Sign up for our free enewsletters to stay up-to-date in your area of practice - or take a look at an archive of prior issues
Join our CESaver program to earn up to 100 contact hours for only $34.95
Explore a world of online resources
Back to Top