Prognosis: Clinical Scenario
You admit a 68 year old male to the ICU who suffered a cardiac arrest while at home. He was successfully resuscitated by emergency medical personnel but had approximately 30 minutes of cardiopulmonary resuscitation. He is intubated and unresponsive to verbal stimulation. He is now 3 days post arrest and has no motor response to pain. The family wants to discuss limiting care if you think he is unlikely to recover. You decide to look for evidence to help advise the family and form the question, 'in patients with no motor response 3 days following a hypoxic coma after a cardiac arrest, what is the chance of good neurological recovery?'
You search MEDLINE using the terms 'anoxic' and 'coma' and find an article Lancet 1994;343:1055-59.
Read the article and decide:
- Is the evidence about prognosis valid?
- Is the valid evidence about prognosis important
- Can you apply this valid and important evidence about prognosis in caring for your patients.