Hypoxic-ischemic brain injury and prognosis after cardiac arrest

Nicole A. Chiota, W. David Freeman, Kevin M. Barrett

Research output: Contribution to journalReview article

15 Scopus citations

Abstract

In 2002, two randomized controlled trials demonstrated that therapeutic hypothermia (32°C to34°C [89.6°F to 93.2°F]) increases the odds of improved neurologic outcome and reduces the risk of death compared with normothermia when applied for the initial 12 to 24 hours after ventricular fibrillation or tachycardia cardiac arrest. Considerable research continues into neurologic prognostication after hypoxicischemic brain injury, especially with the advent of therapeutic hypothermia and its effects on the clinical examination, neurophysiologic studies, and serum biomarkers of brain injury. Recent reports indicate that poor motor response 72 hours after cardiac arrest, absent cortical responses on median nerve somatosensory-evoked potentials, and elevated neuron-specific enolase may not necessarily indicate poor prognosis in patients treated with therapeutic hypothermia compared with historical populations not treated with hypothermia, perhaps because of sedation and neuromuscular blockade. Summary: Neurologic prognostication after cardiac arrest remains challenging because of the sedation and neuromuscular blocking agents given to patients who undergo therapeutic hypothermia. A multimodal algorithmic approach (clinical, electrophysiologic, and possibly serum biomarker testing) is suggested for cardiac arrest patients treated with hypothermia, but further research is needed to determine more accurate prognostic predictors.

Original languageEnglish (US)
Pages (from-to)1094-1118
Number of pages25
JournalCONTINUUM Lifelong Learning in Neurology
Volume17
Issue number5
DOIs
StatePublished - Oct 1 2011

ASJC Scopus subject areas

  • Clinical Neurology
  • Genetics(clinical)

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