Predictors of Neurologic Outcome after Cardiac Arrest
If a patient remains comatose for more than 24 hours after resuscitation from cardiac arrest or after therapeutic hypothermia, the prognostic guidelines developed by the American Academy of Neurology should be used to assess whether the patient has a good or a poor prognosis. Clinical features predicting a poor outcome include absence of pupil or corneal reflexes; absence of noxious motor response other than extensor posturing; and myoclonic status epilepticus. If somatosensory evoked potential (SSEP) responses are absent at day 1, the measurement can be repeated at day 3 or beyond; if N20 responses (N20 is the response 20 msec after electrical stimulation) are lost, the prognosis is poor. Measurement of serum NSE, if immediately available, may also be useful in the prediction of a poor outcome, although validation is needed.
New England Journal of Medicine - Vol. 361, No. 6, August 6, 2009