EARLY PROGNOSIS IN COMA AFTER CARDIAC-ARREST - A PROSPECTIVE CLINICAL, ELECTROPHYSIOLOGICAL, AND BIOCHEMICAL-STUDY OF 60 PATIENTS

Background-The univariate study of clinical, electrophysiological, or biochemical variables has been shown to predict: the outcome in postan oxic coma in about 50% of patients for each type of variable. Previous studies did not, however, consider the prognostic accuracy of a multi variate approach. Methods-Sixty patients in coma for more than six hou rs after cardiac arrest were prospectively examined by means of repeat ed clinical examinations (including Glasgow coma score (GCS)), EEG, an d medianus nerve somatosensory evoked potentials (SEPs). In 16 patient s, the early concentrations of serum neuron specific enolase and ionis ed calcium were also measured. Results-Within the first year after car diac arrest, 20% of patients made a good neurological recovery; 80% re mained in a vegetative state or died. Clinical examination correctly p redicted outcome in 58% of patients, SEP in 59%, and EEG in 41%. The c ombination of clinical examination, SEP, and EEG raised the percentage of correct predictions to 82%, without false pessimistic predictions. Concentrations of serum neuron specific enolase and ionised calcium w ere of no additional prognostic help. Multivariate regression analysis identified the association of GCS < 8 at 48 hours with abnormal or ab sent early cortical SEPs as highly predictive of a bad outcome (risk = 97%, 95% confidence interval = 86-99%). Conclusion-The combination of GCS at 48 hours, SEP, and if these are nonconclusive, EEG, permits a more reliable prediction of outcome in postanoxic coma than clinical e xamination alone.