In this study, we evaluated whether differences in ct measurements expressed in hounsfield units hus of the cerebral cortex and white matter can be used as early predictors of neurological outcome in patients treated with hypothermia therapy after hypoxic ischemic brain damage. Compared with oculocephalic response testing, vor analysis provided more evidence and allowed more precise study of ocular motility in comatose patients. Predicting outcome from hypoxiclschemic coma article pdf available in jama the journal of the american medical association 25310. Postresuscitation management of asphyxiated neonate perinatal asphyxia pa is a major public health problem. This retrospective study included 93 patients with hypoxic brain damage undergoing neurological early rehabilitation length of stay. The prevalence of patients suffering from hypoxic brain damage is increasing. Coma following a hypoxic ischemic event is a serious condition and common reason for admission to the pediatric intensive care unit. One of the most noteworthy was predicting outcome from hypoxicischaemic coma by levy and colleagues, published in 1985. Prognostic value of evoked responses and eventrelated brain potentials in volume 31 issue 4 jing tian wang, g.
An analysis of oculocephalic response and vestibuloocular reflex vor in 81 patients with coma from various causes showed the importance of reflex eye movements for outcome prediction. In the sept 6, 1985, issue of the journal, dr black1 expressed major reservations about applying the scheme for predicting the outcome of hypoxicischemic coma suggested by levy et al. A frequent cause of coma in the intensive care unit is resuscitation following cardiac arrest, for which mortality and severe neurologic disability remain high. Coma following a hypoxicischemic event is a serious condition and common reason for admission to the pediatric intensive care unit. A dedicated service with standardized management protocols and improved communication may help improve care. A prospective clinical and electrophysiologic study.
Although the introduction of therapeutic hypothermia th and improvements in postresuscitation care have significantly increased the number of patients who are discharged home with minimal brain damage, shortterm assessment of neurological outcome remains. Diagnostic term encompassing constellation of pathophysiological and molecular injuries to the brain induced by hypoxia, ischemia, cytotoxicity, or a combination of these busl and greer 2010 common causes. Apr 01, 2020 after neonatal hypoxic ischemic encephalopathy, the presence and severity of central gray matter damage on early brain magnetic resonance imaging accurately predicts adverse motor outcomes at age. In the case of neurologic injury, this can be especially difficult. Predicting clinical outcome in comatose cardiac arrest patients.
Early death and the most severe motor impairment as cerebral palsy were seen in association with basal ganglia injuries 23. Outcome from coma caused by cerebral hypoxiaischemia eg, cardiac. Although recent advances in perinatal medicine have improved perinatal and neonatal mortality rates, the outcome of neonatal hypoxic ischemic encephalopathy hie associated with complications such as placental abruption and cord prolapse is unsatisfactory, often resulting in death or serious sequelae, such as cerebral palsy. The aim of this study was to determine perinatal factors associated with cerebral palsy cp in infants treated with brain hypothermia bht. Treatment options for hypoxic ischemic encephalopathy. Frontiers exploratory use of decision tree analysis in. Outcome after postanoxic coma lasting more than several hours is generally, but not invariably, poor. Article pdf available in jama the journal of the american medical. Neurodevelopmental effect of intracranial hemorrhage. Predicting outcome from hypoxiclschemic coma jama network.
The most characteristic example of hypoxic ischemic brain damage is produced by cardiac arrest. Hypoxic ischemic brain injury hibi after cardiac arrest commonly results in neurological injury and long term dysfunction, with outcomes ranging from coma and vegetative states to functional disability with various degrees of dependence. Therapeutic whole body cooling for hypoxic ischemic. Neurological sequelae of hypoxicischemic brain injury.
Full text is available as a scanned copy of the original print version. Hypoxicischaemic encephalopathy hie queensland health. Knowing also that, after a hypoxicischemic insult, cellular damage on energy substrates continues to evolve over the first 1248 hours, we suggest that the introduction of new neuroprotective strategies and antioxidants in such an early stage of life could change the longterm outcome of these infants. Critical care physicians often find themselves prognosticating for their patients, attempting to predict patient survival as well as disability. Review nursing implications, interventions to anticipate. We aimed to evaluate the impact of a dedicated neonatal neurocritical care service on shortterm outcomes in infants with. Doctors diagnose hie by observing the babys symptoms and performing a physical exam. While progress has also been made in the early identification of patients at greatest risk of poor neurologic outcome after cardiac arrest, reliable prediction of good outcomes, with intact memory and independence, has lagged. Summary of the suggested timing after cardiac arrest of all available tools that are used to predict poor outcome or neurological recovery from coma. Magnetic resonance mr imaging is emerging as one of the most important tools in identifying the etiology of neonatal encephalopathy as well as in predicting longterm outcomes. Quality of survival after outofhospital cardiac arrest. Hypoxicischaemic encephalopathy hie queensland clinical guideline. In this study, we evaluated whether differences in ct measurements expressed in hounsfield units hus of the cerebral cortex and white matter can be used as early predictors of neurological outcome in patients treated with hypothermia therapy after hypoxic.
Involvement of the posterior limb of the internal capsule plic was found to be associated with abnormal motor outcome, 23. The longterm outcomes of babies born with hypoxic ischemic encephalopathy hie can vary widely, from no lasting effects to extensive physical and intellectual impairment requiring 24hour care. Neurological sequelae of hypoxicischemic brain injury ios. Neurological prognostication of outcome in patients in. Although clinical examination remains the preeminent tool to predict the chances of recovery after cardiac resuscitation, a number of. Predictive value of clinical examination in hypoxicischemic brain injury. Implementation of neonatal neurocritical care program. Pdf outcome from coma caused by cerebral hypoxiaischemia eg, cardiac arrest was. Hypoxicischemic encephalopathy clinical presentation. Predicting outcomes after neonatal hypoxicischemic injury.
Neurodevelopmental effect of intracranial hemorrhage observed. Early prediction of hypoxicischemic brain injury by a new. Hypoxicischemic brain injury hibi after cardiac arrest commonly results in neurological injury and long term dysfunction, with outcomes ranging from coma and vegetative states to functional disability with various degrees of dependence. Although the introduction of therapeutic hypothermia th and improvements in postresuscitation care have significantly increased the number of patients who are discharged home with minimal brain damage, shortterm assessment of neurological. Hypoxicischemic encephalopathy is characterized by clinical and laboratory e. Despite major advances in monitoring technology and knowledge of fetal and neonatal pathologies, perinatal asphyxia or, more appropriately, hypoxicischemic encephalopathy hie, remains a serious condition that causes significant mortality and longterm morbidity.
For example, after four months of coma caused by brain damage, the chance of partial recovery is less than 15%, and the chance of full recovery is very low. Hypoxic ischemic injury in adult patients post cardiac. A number of clinical signs and neurophysiological tests, including the electroencephalogram, auditory evoked potentials, and somatosensory evoked potentials ssep, have been reported to predict neurologic outcome in patients with ischemichypoxic brain injury. Predicting the outcome from hypoxic ischemic coma predicting to the editor. This makes it imperative to have a broader understanding of normal myelination of the neonatal brain on mr imaging and to be familiar with the spectrum of imaging features in ischemic and nonischemic. Head computed tomographic measurement as an early predictor. While we fully agree that their data provide a more rational approach for managing patients who sustain hypoxicischemic coma, we wonder about the possibility of a selffulfilling prophecy that potentially confounds these data.
A prospective analysis of 40 patients with hypoxic ischemic coma lasting at least 6 h following sudden cardiac arrest was undertaken. Get a printable copy pdf file of the complete article 453k. Outcome and prognosis of hypoxic brain damage patients. There are very few publications in the literature that address the role of mr imaging in the prediction of coma outcome 6, 7. Despite the introduction of therapeutic hypothermia, infants with moderatetosevere hypoxicischemic encephalopathy remain at risk of mortality and morbidity. To meet the definition of coma by levy et al, patients failed to open their eyes.
Outcome of infants with hypoxic ischemic encephalopathy. Hypoxicischemic brain injury is recognized clinically by a characteristic encephalopathy with either a lack of alertness or hyperalertness, abnormal tone. Attempts to prognosticate outcome accurately after cardiac arrest have generated abundant research. Get a printable copy pdf file of the complete article 453k, or click on a page image below to browse page by page. How to assess prognosis after cardiac arrest and therapeutic. Multimodal prognostication of coma after cardiac arrest and therapeutic hypothermia. Recovery of consciousness reported in the literature varies from 8% to 72% of patients, but is mostly thought to be around 2030% in patients surviving in coma for. Whether the metabolic and cardiopulmonary complications hypoxia, hypoglycemia, shock. The prognosis of patients who are admitted in a comatose state following successful resuscitation after cardiac arrest remains uncertain. The prospect of neurological recovery is poor for many patients, and clinicians are. Get a printable copy pdf file of the complete article. A comparative analysis of the clinical examination, multimodality evoked potentials, ct scanning, and intracranial pressure. This makes it imperative to have a broader understanding of normal myelination of the neonatal brain on mr imaging and to be familiar with the spectrum of imaging features in ischemic and non ischemic neonatal. Summary postanoxic coma is a state of unconsciousness caused by global anoxia of the brain, most commonly due to cardiac arrest.
Full text full text is available as a scanned copy of the original print version. The outcome for coma and vegetative state depends on the cause, location, severity and extent of neurological damage. Read outcome prediction by amplitudeintegrated eeg in adults with hypoxic ischemic encephalopathy, clinical neurology and neurosurgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Most of the data was collected from the literature about neardrowning because of its high prevalence in the state of florida. Treating hypoxic ischemic encephalopathy how is hie diagnosed. Cardiopulmonary arrest respiratory arrest drug overdose carbon monoxide poisoning. Neurology 2011 jun 14 after neonatal hypoxicischemic encephalopathy, the presence and severity of central gray matter damage on early brain magnetic resonance imaging accurately predicts adverse motor outcomes at age 2 years. Mar 08, 1985 predicting outcome from hypoxic ischemic coma. Prediction of neurological outcome using bispectral index. Longterm outcomes of hypoxicischemic encephalopathy. Hypoxic ischaemic encephalopathy refer to online version, destroy printed copies after use page 2 of 27. Neurological prognostication of outcome in patients in coma. Global cerebral hypoxiaischemia was attributed to primary cardiac. Levy and colleagues 1 provide very helpful information about the prognosis of hypoxicischemic coma.
Predicting outcome from hypoxicischemic coma jama jama. Jul 01, 2012 read outcome prediction by amplitudeintegrated eeg in adults with hypoxic ischemic encephalopathy, clinical neurology and neurosurgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Jul 18, 2018 despite major advances in monitoring technology and knowledge of fetal and neonatal pathologies, perinatal asphyxia or, more appropriately, hypoxic ischemic encephalopathy hie, remains a serious condition that causes significant mortality and longterm morbidity. Jan 14, 2014 the prognosis of patients who are admitted in a comatose state following successful resuscitation after cardiac arrest remains uncertain. Jul 24, 2006 critical care physicians often find themselves prognosticating for their patients, attempting to predict patient survival as well as disability. Predicting outcome in children with hypoxic ischemic. This work is an extension of previous publications. How severely hie affects an individual depends on a variety of factors, including. Predicting the neurological outcome in cardiac arrest survivors is of increasing importance to critical care teams and family members. Hypoxic ischemic injury in adult patients post cardiac arrest. Predicting the outcome from hypoxicischemic coma predicting to the editor. Most models predicting outcome of hypoxic ischemic coma have been developed using regression methodology. The most characteristic example of hypoxicischemic brain damage is produced by cardiac arrest. Clinical trials showed that 27% of posthypoxic coma patients regained.
Prognostic value of evoked responses and eventrelated. In this study, features of the neurological examination at different time points in 210 patients with postanoxic coma were related to outcome. Report of the ad hoc committee of the american electroencephalographic society. Persistent coma after global cerebral ischaemia is a serious clinical disorder. Postresuscitation management of asphyxiated neonate. Hypoxic ischemic encephalopathy hie is common in children, and providing accurate and timely prognostic information is important in determining the appropriate level of care. In a recent issue of the journal, levy et al 1 have presented a summary of their work on the outcome of coma in 210 patients with brain hypoxia or ischemia. A prospective analysis of 40 patients with hypoxicischemic coma lasting at least 6 h following sudden cardiac arrest was undertaken. Time is the best general predictor of a chance of recovery.
Clinicians involved in the care of adults in a coma after cardiac arrest are confronted with the increasingly optimistic expectations of next of kin and, in the early phase of intensive care management, neurologists are regularly requested to provide predictions of longterm outcome. Prognosis in severe brain injury gw school of medicine. Google scholar silverman d, saunders mg, schwab rs, masland rl. The longterm outcomes of babies born with hypoxicischemic encephalopathy hie can vary widely, from no lasting effects to extensive physical and intellectual impairment requiring 24hour care. Neuroimaging in neonatal hypoxic ischemic encephalopathy. Knowing also that, after a hypoxicischemic insult, cellular damage on energy substrates continues to evolve over the first 1248 hours, we suggest that the introduction of new neuroprotective strategies and antioxidants in such an early stage of life could change the longterm outcome of.
The patients, all of whom had preserved brainstem function, were studied electrophysiologically with electroencephalography eeg, and median nerve somatosensory evoked potentials seps within 48 h to establish prognostic indices. Links to pubmed are also available for selected references. Neurology 2011 jun 14 after neonatal hypoxic ischemic encephalopathy, the presence and severity of central gray matter damage on early brain magnetic resonance imaging accurately predicts adverse motor outcomes at age 2 years. Predicting the outcome from hypoxicischemic coma jama. Longterm outcome data and prognostic factors for either poor or good outcome are lacking. Objectives brief background on cell physiology and effects of asphyxia describe the pathophysiology and stages of hie discuss the effects of cooling on hie list eligibility criteria for therapeutic whole body cooling examine current data on clinical whole body cooling and data on clinical trials. Because coma has a high rate of mortality and morbidity in.