THE PROGNOSTIC-SIGNIFICANCE OF COMA-RATING, DURATION OF ANOXIA AND CARDIOPULMONARY-RESUSCITATION IN OUT-OF-HOSPITAL CARDIAC-ARREST

Early determination of outcome after successful prehospital cardiopulm onary resuscitation (CPR) is a common problem with great ethical, econ omic, social, and legal consequences. We prospectively investigated 11 2 adult patients who had been resuscitated after out-of-hospital cardi ac arrest (CA). The aim of our study was to determine whether coma rat ing by the mobile intensive care unit (MICU) is a useful tool for outc ome prediction. For neurological assessment the Innsbruck Coma Scale ( ICS) was used initially and after return of spontaneous circulation (R OSC) or 20-30 min after the start of CPR, before any sedating drugs we re given. The duration of anoxia and CPR were determined with the auto matically recorded emergency call protocol of the dispatch centre and the protocol of the MICU. For estimation of cerebral outcome at the ti me of discharge from hospital we used the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). Restoration of spontaneous circulation w as achieved in 42 patients (37%), and 15 (13%) were discharged from ho spital. The first coma rating performed immediately at the time of arr ival on scene had no significant prognostic value for prediction of ne urological outcome (P = 0.204) and survival (P = 0.103). The second co ma rating (performed after ROSC or 20-30 min after the start of CPR), however, demonstrated a significant correlation with neurological outc ome (P = 0.0000) and survival (P = 0.0000), a correlation which was co mparable to both duration of anoxia and duration of CPR. In patients w ith out-of-hospital cardiac arrest prognostic information could be obt ained with the ICS as early as 20-30 min after the start of cardiopulm onary resuscitation.