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Inicio Medicina Clínica (English Edition) Prognostic factors after cardiac arrest. Usefulness of early video-electroenceph...
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Vol. 144. Issue 9.
Pages 397-400 (May 2015)
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Vol. 144. Issue 9.
Pages 397-400 (May 2015)
Brief report
Prognostic factors after cardiac arrest. Usefulness of early video-electroencephalogram
Factores pronósticos tras paro cardiorrespiratorio. Utilidad del vídeo-electroencefalograma precoz
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Fernando Arméstara,
Corresponding author
, Juan Luis Becerra Cuñatb, Yariela León Chana, Eduard Mesalles Sanjuana, José Antonio Morenoa, Marta Jiménez Gonzálezb, Josep Rocac
a Servicio de Medicina Intensiva, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
b Servicio de Neurología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
c Servicio de Epidemiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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Tables (4)
Table 1. Causes of cardiopulmonary arrest.
Table 2. Glasgow Outcome Scale of patients until the third month (n=50).
Table 3. Prognostic factors of hospital mortality. Univariate analysis (n=50).
Table 4. Prognostic factors of hospital mortality. Multivariate analysis (n=50).
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Abstract
Background and objective

Predictors of unfavourable outcome in patients after cardiopulmonary arrest (CPA) are important to make decisions about the limitation of therapeutic efforts. The aim was to analyse the clinical variables in the prognosis of patients recovered after CPA.

Material and method

Retrospective study on comatose patients with recovered CPA. The variables were: age, sex, Glasgow Coma Score (GCS), pupillary light reflex, other variables related to CPA (cause, duration, witnessed or not witnessed), myoclonic status and electroencephalographic (EEG) patterns.

Results

Fifty patients were studied. The variables associated with mortality were the absence of pupillary light reflex (hazard ratio [HR] 0.277, 95% confidence interval [95% CI] 0.103–0.741, P=.01), a low GCS (HR 0.701, 95% CI 0.542–0.908, P=.007) and myoclonic state (HR 0.38, 95% CI 0.176–0.854, P=.01). We evaluated the EEG patterns in 22 patients. No statistical significance was observed.

Conclusions

The absence of pupillary light reflex, a low GCS and myoclonic state are prognostic factors in patients recovered after a CPA. The EEG patterns showed a nonsignificant association with prognosis.

Keywords:
Cardiopulmonary arrest
Anoxic coma
Electroencephalogram
Resumen
Fundamento y objetivo

La valoración de los enfermos tras un paro cardiorrespiratorio (PCR) es importante para la toma de decisiones sobre la limitación del esfuerzo terapéutico. El estudio buscó factores pronósticos en los pacientes tras un PCR recuperado.

Material y método

Estudio retrospectivo de enfermos en coma tras un PCR. Se analizaron la edad, el sexo, el Glasgow Score Coma (GCS), los reflejos pupilares, las variables relacionadas con el PCR (causa, duración, presenciado o no presenciado), el estatus mioclónico y los patrones del electroencefalograma (EEG): mal pronóstico, pronóstico incierto y benigno.

Resultados

Se estudiaron 50 enfermos. Las variables asociadas con mortalidad fueron la ausencia de reflejos pupilares (riesgo relativo [RR] 0,277, intervalo de confianza del 95% [IC 95%] 0,103-0,741, p=0,01), el GCS bajo (RR 0,701, IC 95% 0,542-0,908, p=0,007) y el estatus mioclónico (RR 0,38, IC 95% 0,176-0,854, p=0,01). En 22 pacientes se analizaron los patrones del EEG, sin apreciarse significación estadística.

Conclusiones

La ausencia de reflejos pupilares, la baja puntuación del GCS y el estatus mioclónico son factores de mal pronóstico en pacientes tras un PCR. Los patrones del EEG mostraron una tendencia no significativa de asociación con el pronóstico.

Palabras clave:
Paro cardiorrespiratorio
Coma anóxico
Electroencefalograma

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